Demodex treatment in external ocular disease: the outcomes of a Tasmanian case series

Abstract

Demodex species (spp.) have previously been implicated in the pathogenesis of blepharitis. This study aims to correlate improvement in symptoms of external ocular disease with treatment of underlying Demodex spp. This is a prospective, observational case series of patients with chronic external ocular disease. Demodicosis was confirmed by microscopic examination of epilated eyelashes. The main outcome measure was response to the treatment (5 % tee tree oil) in regard to change in subjective symptoms utilising a symptom-based patient questionnaire assessment. Overall patients had a good response to the treatment in terms of improvement or resolution of symptoms, with 91 % of patients reporting at least some improvement in symptoms. The treatment of underlying Demodex spp. appears to result in improvement of symptoms in patients with long standing external ocular disease and underlying Demodex spp. infestation.

<p>Improvement in ocular symptoms and signs in patients with <em>Demodex</em> anterior blepharitis using a novel terpinen-4-ol (2.5%) and hyaluronic acid (0.2%) cleansing wipe</p>

“…15 A study performed by Koo et al 14 previously showed that only 38% of patients adhered to the treatment (10% TTO daily scrubs in addition to a 50% TTO weekly scrub) with the efficacy of TTO vs control only observed in compliant patients. In a similar study by Nicholls et al, 25 non-compliance was estimated at 25%. This is in comparison to our observed non-compliance rate of 0% in Group 1 and 4% in Group 2 (one patient with compliance <80%), which could be a result of the reduced adverse effects of T4O alone and at a lower concentration when compared with other Demodex treatment regimens.…”

“…A longer-term study (three months) similarly demonstrated the efficacy of such a treatment against Demodex blepharitis, using 5% TTO applied once daily on patients with chronic ocular disease and Demodex infestation, reducing ocular symptoms by 91%. 25 However, these results are based on treatments using varying concentrations of TTO and at present, there is very little data regarding the performance and safety of T4O in reducing Demodex mites and improving symptoms. Tighe et al 15 have reported the case of a 61year-old woman treated twice daily for 8 weeks with T4O wipes (Cliradex ® ).…”

“…However, it can be difficult to ensure patients adhere to a treatment regimen, and the ease, comfort, and convenience of use are believed to facilitate compliance in the longer term. 9,31 Whilst previous reports using differing concentrations of TTO have generally proved effective in reducing ocular signs and symptoms of Demodex-associated blepharitis, 14,[23][24][25]32 all have reported major compliance issues, potentially related to the adverse effects of other ingredients contained within TTO. 15 A study performed by Koo et al 14 previously showed that only 38% of patients adhered to the treatment (10% TTO daily scrubs in addition to a 50% TTO weekly scrub) with the efficacy of TTO vs control only observed in compliant patients.…”

A Clinical Scoring System for Diagnosis of Ocular Demodicosis

“…We found that Demodex ratio was approximately 77% in chronic and treatment-refractory patients. In Tasmania, which is more of an agricultural and forestry region, Demodex positivity was found in 99% of patients with chronic ocular surface disease [ 12 ]. A study conducted in Seoul, one of the most developed cities in Korea, found that the Demodex ratio in the routine examination of eye disease in outpatient clinics was 70% [ 13 ].…”

“…In a study conducted in Tasmania, it was reported that symptoms decreased in 91% of patients with 5% TTO use. In the same study, it was revealed that the patients who recovered the least were those who had underlying dry-eye disease [ 12 ]. Gao et al [ 18 ] found that weekly eye lid cleaning with 50% TTO and daily eye lid cleaning with 5% TTO were effective.…”