Upper Eyelid Nodule - An Unusual Presentation of Ocular Demodicosis

Introduction: Demodex mite is an external parasite which is implicated in various ocular conditions like anterior blepharitis, posterior blepharitis, meibomian gland dysfunction, chalazia and others. Although demodex has been shown to be a causative agent of chalazia, occurrence of a solitary inflammatory nodule due to demodex infestation has not been reported in literature. Case: Our case describes the occurrence of an upper eyelid mass in a 62-year-old female which was found to have an associated demodex infestation. Conclusion: This is the first report of demodex infestation presenting as a nodular eyelid mass. This parasite needs to be considered in the differential diagnosis of eyelid masses as this condition requires specific management.

Occurrence of Demodex infestation in chronic blepharitis in a tertiary care hospital in North-East India

Background: Chronic blepharitis is frequently encountered by ophthalmologists. Demodex mites (Demodex folliculorum and Demodex brevis) can play a role in its pathogenesis, especially in treatment-resistant cases. Demodex infestation often remains underdiagnosed and undertreated. Definitive diagnosis can be made with lash-sampling. Objective of the study was to find the association between Demodex infestation and chronic blepharitis.Methods: The study included 80 patients diagnosed with chronic blepharitis and 80 controls without blepharitis. Four eyelashes were epilated from each lower and upper lids of the right and left eye (a total of sixteen samples) of each participant. Eyelash samples were examined under a light microscope and Demodex species were identified and counted.Results: Demodex mites were detected in 45 cases (56.25%) and 14 controls (17.5%). Significant association was found between demodex infestation and blepharitis as odd’s ratio was found to be 6.0612 and p value <0.0001. D. folliculorum was detected in 42 cases, D. brevis in 2 cases while in one case, both were detected. The mean age for Demodex positive cases and controls were 49.78±13.25 and 64±7.86 years, respectively. Amongst the cases, Demodex was detected in 57.69% males (30 out of 52) and 53.55% females (15 out of 28).Conclusions: There is significant co-relation between Demodex infestation and chronic blepharitis. Demodex infestation should be part of the differential diagnosis of chronic blepharitis.

A Survey on How Ocular Surface Demodex Infestation Interactively Associates with Diabetes Mellitus and Dry Eye Disease

Purpose Prevention of ocular surface (OS) Demodex infestation plays an important role in OS hygiene and variety of factors may be associated with it, in which diabetes mellitus (DM) or dry eye disease (DED) has caught the attention of most scholars. However, there has been no research on whether there was a potential interaction between DM and DED in the process of OS Demodex infestation. This cross-sectional study was implemented in Zhujiang Hospital of Southern Medical University. Methods Ophthalmologic interviews, questionnaires, and examinations were conducted. Factors including general information, DM status, dry eye condition, etc. were collected to study the correlation of DM and DED on OS Demodex infestation. Results After statistical analysis, we found that both DM (P < 0.001) and DED (P = 0.013 < 0.05) are closely associated with OS Demodex infestation. Compared with DED, DM has higher priority association with OS Demodex infestation, and patients with both diseases have a significant higher risk of OS Demodex infestation (R = 0.197, P < 0.001). Meanwhile, age (R = 0.299, P < 0.001) and hypertension (P < 0.05) were also correlated with OS Demodex infestation. Conclusion This study provides a new evidence-based basis for clinical prevention and management of OS Demodex infestation.

Case of Angular Blepharitis Caused by Demodex folliculorum

Angular blepharitis is inflammation of the eyelid skin at the lateral canthus, most commonly caused by Staphylococcus and Moraxella species. The Demodex mite is an external parasite that often infests the human eyelid margin and has been implicated in both anterior and posterior blepharitis. The authors describe the case of a 43-year-old female who presented for evaluation of a 3-month history of bilateral canthal eyelid irritation, consistent with angular blepharitis. This is a case report and review of relevant literature. Skin biopsy showed evidence of Demodex folliculorum infestation. Multiple D. folliculorum organisms were visualized within the hair follicles and on the surface, along with pockets of acute and chronic nongranulomatous inflammation surrounding hair follicles. The patient was treated with tea tree oil applied to her eyelids and eyelashes twice daily with complete resolution of symptoms. To our knowledge, this is the first report of angular blepharitis with histopathologic confirmation of Demodex infestation. In this discussion, we cover manifestations of the Demodex mite, angular blepharitis, and treatment options. Due to the lack of literature regarding this entity, we feel that it may be an underrecognized periocular and dermatologic condition that can lead to misdiagnosis, visits to multiple practitioners, and significant functional and cosmetic sequelae to the patient. Demodex infestation should be considered on the differential diagnosis for cases of refractory angular blepharitis, particularly when unresponsive to topical steroids. Based on results from treating Demodex anterior and posterior blepharitis and this case, treatment with tea tree oil should be considered.