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  • Demodex blepharitis-blecch

    Many thanks to Erik for telling us about his appointment with Dr. Tseng and about Demodex. Once I got control of my nausea I poked around to learn more as I'd never heard of it.

    This is one of the least offensive explanations that doesn't make you look at pictures if you don't want to .

    http://www.onjoph.com/english/demodex-body.html

    Demodex folliculorum in chronic blepharitis

    A. Jünemann
    Department of Ophthalmology, University of Erlangen-Nürnberg (Chairman: Prof. Dr. G.O.H. Naumann)
    Schwabachanlage 6, D-91054 Erlangen, Germany

    Background and Purpose. The mite demodex folliculorum (Class Arachnida, Order Acarina), first described by Berger in 1841, can be found in the hair follicles of the eyelashes and of the contigous facial skin. The shorter species Demodex brevis inhabits meibomian and other sebaceous glands. The live cycle of the mite is 14 ½ days. The about 300µm long adult mite lives 5 to 6 days in the follicle of the eyelash or hair, can migrate on to the skin during night time (negative phototrop) by moving 1cm per hour. The classic clinical appearance are "sleeves", 1mm long cylindrical cuffs around the base of the eyelashes. The association of demodex with diseases like blepharitis, lid hyperemia, meibomitis, chalazion or rosacea is controversal discussed. Also the vector capacity of demodex for bacterial infections remains unclear. The incidence of demodex is age related. It was found up to 20 years in about 25%, up to 50 years in about 30%, up to 80 years in about 50% and in all aged 90 or older. In healthy persons, one can find one or more Demodex in every tenth eyelash. This index rise with increasing age. In blepharitis or other external eye diseases, demodex is found in about every sixth eyelash. Therapy of chronic blepharitis in association with demodex may include antibiotics, steroids, Quecksilber 2% or Lindan. Massage of lidmargins is essential because local treatment is of no effect as long as the mite remains deep in the pilosebaceous complex.

    Patient and Methods. A 54-year old man suffered from therapy resistent chronic blepharitis without improvement under therapy of antibiotics and/or steroids. Symptoms were itching, foreign body sensation and epiphora. There was anterior and posterior blepharitis with thickening and vasodilatation of the lid margins. On slitlamp examination, several "sleeves" at the base of eyelashes were detected. 6 eyelashes of the lower lid from both sides were epilated, transferred to a glass slide and promptly examined by lightmicroscopy.

    Results. Adharent to the hair bulb of several epilated eyelashes one or two Demodex folliculorum were seen. The video shows two mites, situated with the head downwards towards the root of the eyelash. One is located between the cuticula and Huxley’s layer. One can see the prosoma incorporating head and thorax (cephalothorax), provided with four pairs of legs, and the opisthosoma consisting of abdomen and tail. At the head, two lateral palps and a U-shaped formation, between the palps and behind a beak-shaped growth, move actively. The three telescopic segments of the legs move at intervals, frequently only one leg at a time. The tail moves up and down. The abdomen is filled up by granules and vacuole-like formations.

    Conclusion. Epilation of eyelashes and subsequent microscopic examination is an easy and effective method for detecting demodex folliculorum. Instead the role o the mite in diseases of ocular region is uncertain, Demodex should be considered in chronic therapy resistent blepharitis. Beside of "sleeves" gnawed and stunted, easely epilated eyelashes may be clinical signs for demodex folliculorum. The higher incidence of demodex may play a pathogenic role in ocular diseases.



    Literature of interest:

    Demmler M, Mino de Kaspar H, Möhring C, Klauß V. Blepharitis. Demodex foliculorum, assoziiertes Erregerspektrum und spezifische Therapie. Ophthalmolgoe 1997; 94: 191-196.

    English FP, Iwamoto T, Darrell RW, DeVOe AG. The vector potential of Demodex folliculorum. Arch Ophthalmol 1970; 84: 83-85.

    English FP. Demdex folliculorum and oedema of the eyelash. Brit J Ophthalmol 1971; 55: 742-749.

    Forton F, Seys B. Density of Demodex follicuorum in rosacea: a case-control study using standardized skin-surface biopsy. Br J Dermatol 1993; 128: 650-659.

    Liotet S, Cochet P, Couette P. Die Milbe "demodex folliculorum" Ihre Bedeutung bei Kontaktlinsenträgern. Contactologica 1979; 1: 111-118.

    Norn MS. Demodex folliculorum. Incidence and possible pahogenic role in the human eyelid. Acta Ophthalmologica 1970; 108 (Suppl): 7-85.

    Norn MS. Die Haarbalgmilbe Demodex folliculorum hominis - ihre Rolle in der Ophthalmologie. Contaktologica 1981; 3: 98-102.

    Norn MS. Incidence of demodex folliculorum on ski of lids and nose. Acta Ophthalmlogica 1982; 60: 575-583.

    Raehlman E. Über Blepharitis acaria. Eine Erkrankung der Wimpern und Lidränder in Folge von Milben in den Cilienbälgen. Monatslb Augenheilkd. 1899; 33-51.

    Anselm Jünemann
    Schwabachanlage 6
    Department of ophthalmology of university of Erlangen-Nürnberg
    91054 Erlangen, Germany
    telefone: 09131/853001
    fax: 09131/856401

    email: anselm.jünemann@augen.med.uni-erlangen.de
    Cindy

    "People may not always remember exactly what you said or what you did, but they will always remember how you made them feel." ~ Unknown

  • #2
    Very Informative

    Cindy, I was going to make a few comments on this last night. I could not bring myself to do so. Yechhhhhhh. I'm glad I didn't and you have provided us with all the information we need to know. Thanks! I think I'll skip breakfast.

    Lucy
    Don't trust any refractive surgeon with YOUR eyes.

    The Dry Eye Queen

    Comment


    • #3
      shocker

      Demodex was most certainly NOT listed on my informed consent form!

      Erik,

      Do keep us updated on this. We may all have some new friends we didn't know about.

      Diana
      Never play leapfrog with a unicorn.

      Comment


      • #4
        Here's some more info (might as well skip lunch too, Luce ).

        WARNING - pictures at the bottom of the page:

        http://www.emedicine.com/oph/topic517.htm
        Cindy

        "People may not always remember exactly what you said or what you did, but they will always remember how you made them feel." ~ Unknown

        Comment


        • #5
          Grossness

          As disgusting as the web pictures are, this is way more horrifying when you look at these live, under a microscope, with their little legs squirming around, attached to eyelashes that were just pulled of of your face! The doctor who brought me in to look under the microscope with her told me, on the way to the scope room, "don't be scared." I thought she was joking.

          BTW, Dr Tseng said these generally come from dogs, who have bazillions of them on their hairy bodies. He told me to keep my dog out of my room and most definitely off of my bed. I had to admit to him, that when I came home from work at night, the dog would often be asleep, curled up against my pillow. Now I am afraid to touch the poor creature, and I wash my hands a LOT (even for a doctor).

          Comment


          • #6
            I don't show any real signs of eyelid problem, and never felt it worthwhile to do lid scrubs. In fact, upon examination my eyes are perfectly healthy - contradicting all my complaints. Still, I've been thinking about this demodex thing...I'm going to treat for it. This LASIK thing has been such raw deal, why not add unwanted critters to the list?

            On the web site Cindy posted, these are the suggestion for treatment:

            * 50-50 mixture of baby shampoo and water

            * Erythromycin ointment

            * Mercury oxide 1% ointment

            * Pilocarpine 4% gel

            Also discussed on the critter site is demodex copulation and egg laying. It's hard to believe there's all that activity going on at the eyelash "level"...and it's right in front of our faces.

            I have the erythromycin ointment so I'll give that a try. I purchased it to use in my eye, but it made me miserable. I'll use it on my lids this time. Also, I'll break down and do some gentle lid scrubbing. I'll let you know how it goes...

            Erik, have you shown signs of improvement yet? Are you scheduled to go back to see Dr. Tseng soon?
            Never play leapfrog with a unicorn.

            Comment


            • #7
              No improvement yet (or maybe a very modest improvement), but am only 9 days out, so I'm not throwing in the towel quite yet. Tseng thought I should feel better in a month or so.

              Comment


              • #8
                Durable Critters

                So, the little buggers are quite durable, huh? Figures.

                Lucy
                Don't trust any refractive surgeon with YOUR eyes.

                The Dry Eye Queen

                Comment


                • #9
                  From the Review of Optometry 3/15/04 issue. Ya gotta love optometrists. Of note in this article is mention that demodex have a preference for munching omega 6 oils (yummy) but not omega 3s, so dietary changes could be part of the solution.

                  http://www.revoptom.com/index.asp?page=2_1117.htm

                  Put a Lid on Demodex

                  How to diagnose these parasites and control the infestation.

                  Edited By Joseph P. Shovlin, O.D

                  Q. I suspect a 78-year-old aphakic lens wearer with itching and burning eyelids has Demodex. What is the life cycle and how do I diagnose it?

                  A. Demodex folliculorum is a four-legged, elongated and semi-transparent parasitic mite, which resides in the ducts of the sebaceous glands that are near or connected to hair follicles.1 Demodex, which is a form of blepharitis, lives between 18-24 days, during which the females lay 20-24 eggs.

                  Some infestations may be related to poor hygiene, perioral dermatitis, rosacea and diabetes, though incidence of Demodex apparently increases with age, mostly affecting the elderly.2-4

                  “If a patient has red eyes, thickened eyelids at the margin, redness along the margin, perhaps a loss of lashes and complains of itching and burning—which may be exacerbated during warmer weather—you should immediately suspect lid disease,” says Bobby Christensen, O.D., of Midwest City, Okla. “And if I should notice a large group of eyelashes missing and an ulcer or eroded spot on the lid, I am going to consider masquerade syndromes like basal cell carcinoma.”

                  According to Jacksonville, Fla., optometrist Louis Catania, Demodex, like other forms of blepharitis, appear as collarettes around the base of the lashes (which can be seen by the naked eye if there are enough of them) and therefore, make the hair follicle appear as a puckered pyramid. “You will observe a concretion or an exudate surrounding the lash,” Dr. Cantania says.

                  Epilation of several lashes, when floated on viscous fluid under light microscopy, will reveal the mites. If six or more are found on 16 epilated lashes, there is an overpopulation.

                  Q. Can we ever get rid of Demodex when it inhabits the lid area?

                  A. Demodex can never completely be eliminated, but the infestation can be controlled. “It is the toxins and the waste they give off that cause most of the reaction, so if you can reduce the population, that will basically keep the eyelids looking good and the patient comfortable,” Dr. Christensen says.

                  Treatment consists of:
                  • Lid scrubs. “Since the adult mite hides in the hair follicle, it’s the physical manipulation and tugging that makes lid scrub the most effective form of treatment,” says Joseph B. Fleming, O.D., of Birmingham, Ala.

                  Dr. Catania recommends morning, night and even mid-day lid scrubs, if possible.
                  • Topical antibiotic. Demodex is often treatable with polymyxin B/bacitracin ointment. “You want the patient to rub it in down to the base of the lash, twice a day,” Dr. Christensen says. “Fifteen minutes after they put the ointment in, in the morning, they should rinse their eyes out with saline solution, so they don’t trap any of the ointment under the lens or smear the top of it.”

                  • Dietary changes. According to Robert Abel, M.D., of Wilmington, Del., by decreasing intake of Omega-6 fatty acids (eggs, for instance) and boosting Omega-3s (cod, for instance), you can take care of the problem in the long-run. “One of the reasons we get seborrhea and related conditions is because of the dietary contributions to meibomian secretions,” he says. “But the oils from Omega-3 do not taste as good to them, so by changing your diet, since these oils get onto contact lenses, you’ll be limiting the annoyance.”

                  1. Umar MH. Demodex, an inhabitant of human hair follicles, and a mite which we live with in harmony. Micscape Magazine, May 2000, www.microscopy-uk.org.uk/mag
                  /artmay00/demodex.html.
                  2. Sibenge S, Gawkrodger DJ. Rosacea: a study of clinical patterns, blood flow, and the role of Demodex folliculorum. J Am Acad Dermatol 1992 Apr;26(4):590-3.
                  3. Clifford CW, Fulk GW. Association of diabetes, lash loss, and Staphylococcus aureus with infestation of eyelids by Demodex folliculorum (Acari: Demodicidae). J Med Entomol 1990 Jul;27(4):467-70.
                  4. Norn MS. Incidence of Demodex folliculorum on skin of lids and nose. Acta Ophthalmol 1982 Aug;60(4):575-83.



                  Vol. No: 141:03Issue: 3/15/04
                  Cindy

                  "People may not always remember exactly what you said or what you did, but they will always remember how you made them feel." ~ Unknown

                  Comment


                  • #10
                    I don't post too often. I quit doing so back on SE. My emotional state can't take it. I become obsessed. So I've learn to live with my problem. Now pregnant and teaching again, things are getting worse. So I've been lurking. I am glad I did. I think those stinking mites might be my problem. All the explanantions fit my eyes perfectly. I found a website that had some simple basic explanations (I don't think it's been referenced yet). It is a Chinese herbal site. I'm not sure how I feel about that stuff, but everything I read was easy too read and sounded good. I just thought I'd share the website...they even sell an eye ointment for demodex blepharitis.

                    http://www.demodexsolutions.com/defa....asp~mainFrame

                    Hope it is useful.

                    Maurie

                    Comment


                    • #11
                      RE: dogs..........

                      Are these critters only on people with pets? I don't have dogs or cats, so do i orobably have the little buggers?
                      Don't trust any refractive surgeon with YOUR eyes.

                      The Dry Eye Queen

                      Comment


                      • #12
                        No Lucy, I don't have any pets yet I have had blepharitis since I had my lasik surgery. I didn't know I had it at first until I told my eye doc that my eyelashes were falling out. He looked surprised, then looked at my bottom lids and told me to notice how they were scaly and raised. You can even see it with just a regular mirror. I've been using saline solution with a q-tip to go back and forth over the area at night and sometimes a warm washcloth and I also use the erymthycin ointment and have used it for about 2 months now. I haven't noticed any improvement really. All I can say is, thank God I can't see what these creatures look like with my normal eyes! Yuch!

                        Comment


                        • #13
                          demodex/blepharitis

                          Kyle - your answer confuses me. Demoxdex and blepharitis are two separate things, aren't they? Or perhaps I am reading your post wrong??

                          Comment


                          • #14
                            Pilocarpine gel seems very effective.

                            Pilocarpine gel seems very effective.
                            ---------------------
                            Optom Vis Sci. 1996 Dec;73(12):742-5. Related Articles, Links

                            Fulk GW, Murphy B, Robins MD.

                            College of Optometry, Northeastern State University, Tahlequah, Oklahoma, USA.

                            BACKGROUND: Excessive numbers of the mite, Demodax folliculorum, in the eyelash follicies cause itching and is referred to as demodicosis. We evaluated 4% pilocarpine gel as a treatment for this condition. METHODS: An advertisement was placed in a retirement home newsletter, requesting persons with ocular discomfort. Respondents were examined for Demodex and persons with abundant mites were invited to participate. One eye was treated with pilocarpine gel; the other eye was untreated. The relative abundance of mites was evaluated at baseline, after 1 and 2 weeks of treatment. Subjects kept a daily log of symptoms. RESULTS: Eleven of 22 persons with ocular itching had abundant Demodax. Mites were reduced significantly by the treatment (p = 0.017). The amount of mite reduction was closely correlated with the extent to which itching was alleviated (r = 0.811, p = 0.008). CONCLUSION: Abundant Demodex is an important cause of ocular itching in older persons. Mites can be reduced with pilocarpine gel and itching alleviated.

                            Comment


                            • #15
                              Originally posted by jcorbett
                              Kyle - your answer confuses me. Demoxdex and blepharitis are two separate things, aren't they? Or perhaps I am reading your post wrong??
                              That's a good question...I always thought they were the same thing. The way my eye doc described it to me it seemed like it was. Am I wrong?

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