Background: Demodex infestation is highly age-dependent. Intriguingly, our previous studies that focused on children and young adult patients suggested that the clinical features of young patients were different from those studies enrolling mainly elderly patients. Whether age plays a role between young and elderly patients with ocular demodicosis remains unclear.Methods: This prospective comparative study included 91 patients younger than 35 years and 92 older than 45 years with ocular demodicosis. Demodex mite count, symptoms, tear film, and ocular changes were compared between the two groups. Risk factors of meibomian gland loss (MGL) and corneal changes were analysed in the two groups.Results: Demodex counts were comparable between the two groups. Young patients had higher D. brevis counts and overall percentage of D. brevis, while elderly patients had more D. folliculorum (all P<0.05).Irritation and blurred vision were more common in young patients, while eye fatigue and photophobia were more common in elderly patients (both P<0.05). The two groups had comparable tear volume and tear break-up time. Meibomian gland dysfunction was the most common sign in both groups but MGL was significantly more severe in young patients. More prevalent corneal changes and more eyelash disorders were found in young patients (both P<0.05). Female sex, a higher D. brevis percentage, lid margin anomalies, and MGL were associated with corneal change, while a higher D. brevis percentage and lid margin anomalies were related to MGL in young patients. MGL was associated with corneal change, but age was the only predictor of MGL in the elderly group.Conclusions: Young patients with ocular demodicosis tend to have more D. brevis infestation, more MGL, and more corneal involvement.

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Background: After allogeneic hematopoietic stem cell transplantation (allo-HSCT), patients are followed up by transplant clinicians. Finding an effective primary screening method that transplant clinicians or patients can master is essential in the early referral of suspected chronic ocular graft-versus-host disease (coGVHD) to an ophthalmologist. This study investigated if the ocular surface disease index (OSDI) questionnaire could be used for coGVHD primary screening.Methods: This case-controlled, cross-sectional study enrolled 161 allo-HSCT patients. All participants completed an OSDI questionnaire and underwent a silt-lamp examination. Bulbar conjunctival injection (BCI) was assessed using torchlight, while tear volume was measured via the Schirmer test (ST). The receiver operating characteristic curve was used to evaluate the sensitivity, specificity, and cutoff values of OSDI, ST, and BCI grading. Performance comparisons of the 3 tests applied in isolation, parallel, and series were made.Results: There were 84 patients with and 77 patients without coGVHD. Compared to those without coGVHD, patients with coGVHD had significantly higher median values of OSDI, corneal fluorescein staining, conjunctival injection, conjunctival fibrosis, and meibum quality, but lower ST scores (All P values <0.001). The cutoff values for OSDI, ST, and BCI grade in the diagnosis of coGVHD were 19.4 points, 7 mm, and grade 0, respectively. The sensitivity and specificity of the tests based on the cutoff values were, respectively, 89.3% and 89.6% for OSDI, 91.7% and 59.7% for ST, and 78.6% and 70.1% for BCI. The area under the curve (AUC) value of OSDI was significantly higher than that of ST (0.931 vs. 0.826; P=0.010) and BCI grade (0.931 vs. 0.781; P<0.001). The AUC values of the combinations were lower than that of OSDI alone. Conclusions:The OSDI questionnaire can be used as a simple screening test for coGVHD as demonstrated by its high sensitivity and specificity in the transplant clinic and patients' self-monitoring. An OSDI greater than 19.4 could be considered an ophthalmology referral criterion.