The correlation between facial and eyelid demodicosis. Complex therapeutic approaches

Aim. To assess the correlation between eyelid and facial demodicosis and to develop an optimal anti-parasitic treatment schedule for posterior blepharitis associated with eyelid demodicosis. 

Materials and methods. 100 patients with posterior blepharitis associated with eyelid demodicosis were enrolled in the study. The patients were divided into 2 groups depending on Demodex count. Demodex count less than 4 mites was considered normal while Demodex count more than 4 mites was considered pathological. 60 patients with Demodex count more than 4 mites were subdivided into 2 groups. Study group patients (n = 30) received anti-parasitic therapy with preceding anti-inflammatory treatment, eyelid hygiene and massage. Control group patients (n = 30) received antiparasitic therapy only. Patients with verified facial demodicosis received dermatological treatment as well. In all patients, integral indices of subjective discomfort and objective signs of posterior blepharitis were measured, Schirmer’s and Norn’s tests were performed, functional state of meibomian glands was evaluated (compressive test). 

Results. Eyelid demodicosis was associated with facial demodicosis in 48% of patients. In 10%, Demodex count was less than 4 mites. In 38%, Demodex count was more than 4 mites. Skin lesions were revealed in 1% of patients with Demodex count less than 4 mites and in 20% of patients with Demodex count more than 4 mites. Anti-parasitic therapy with preceding anti-inflammatory treatment, eyelid hygiene and massage improved functional state of meibomian glands and objective signs of posterior meibomian blepharitis. In 1.5 months after the treatment, Demodex was absent in 80% of study group patients and 56.6% of controls. 

Conclusion. Stepwise treatment of posterior blepharitis associated with eyelid demodicosis (anti-inflammatory and anti-parasitic therapy, eyelid hygiene) is effective and provides prolonged remission. 

1. Akbulatova L.Kh. [Pathogenic role of Demodex and clinical variants of human demodicosis]. Patogennaya rol’ kleshcha Demodex i klinicheskie formy demodikoza u cheloveka. [Annals of Dermatology and Venereology]. Vestnik dermatologii i venerologii. 1966; 12: 57-61. (in Russ.).

2. Salem D.A., El-Shazly A., Nabih N., El-Bayoumy Y, Saleh S. Evaluation of the efficacy of oral ivermectin in comparison with ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum. S. Int. J. Infect. Dis. 2013; 17 (5): 343-347.

3. Zatsepina N. D., Maychuk Yu. F., Semenova G. Ya. [Ocular demodicosis: Methodological guidelines]. Porazhenie glaz pri demodekoze: Metodicheskie rekomendatsii. Мoscow, 1983. (in Russ.).

4. Todor G.Yu., Zavgorodnyaya V.P., Cheiber Z.T., Stoykaya T.I., Belun I.A. [Clinical features and complex treatment of ocular and facial demodicosis]. Klinicheskie osobennosti i opyt kompleksnogo lechenie demodekoza glaz i kozhi litsa. [Ophthalmological Journal]. Oftal’mologicheskiy zhurnal. 1990; 7: 443-445. (in Russ.).

5. Rufli T., Mumcuoglu Y. The hair follicle mites Demodex folliculorum and Demodex brevis: biology and medical importance. Dermatology. 1981; 162 (1): 1-11.

6. Junk A.K., Lukacs A., Kampik A. Klin. Monatbl. Augenheilkd. Topical administration of metronidazole gel as an effective therapy alternative in chronic Demodex blepharitis — a case report. 1998; 213 (1): 48-50.

7. Aznabaev M.T., Gumerova E.I., Mal’khanov V. B. [Ocular demodicosis: Educational methodological guidelines]. Demodekoz glaz: Uchebno-metodicheskoe posobie. Ufa, 2002. (in Russ.).

8. Zheltikova T.M. [Demodicosis: Myths and reality]. Demodekoz: mify i real’nost’. [Family Medicine]. Semeynaya meditsina. 2012; 1: 36-38. (in Russ.).

9. English F. P., Nutting W. B. Demodicosis of ophthalmic concern. Am. J. Ophthalmol. 1981; 91 (3): 362-372.

10. Sirmays N. S., Abesadze G. A., Ustinov M. V. [Demodicosis: pathogenic aspects in various facial dermatosis: Methodological guidelenes]. Demodekoz: patogeneticheskie aspekty pri razlichnykh dermatozakh litsa: Metodicheskoe posobie. Мoscow, Gel’tek-Medika, 2013. (in Russ.).

11. Koo H., Kim T. H., Kim K. W., Wee S. W., Chun Y. S., Kim J. C. Ocular surface discomfort and Demodex: effect of tea tree oil eyelid scrub in Demodex blepharitis. J. Korean Med. Sci. 2012; 27 (12): 1574-1579.