Demodicosis Clinical Presentation

  • Author: Manolette R Roque, MD, MBA; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jun 29, 2011
 

History

  • Symptoms
    • Ocular irritation
    • Itching
    • Scaling of lids
  • Past ocular history - Recurrent failed treatment of blepharitis
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Physical

  • Gross observation
    • Lid thickening
    • Scaling of lids
    • Madarosis (loss of lashes)
    • Conjunctival inflammation
    • Meibomian gland dysfunction
    • Rosacea
    • Decreased vision
  • Slit lamp findings
    • Collar of tissue around the base of the eyelashes
    • Follicular distention
    • Dry eye
    • Cornea
      • Superficial corneal vascularization
      • Marginal corneal infiltration
      • Phlyctenule-like lesion
      • Superficial corneal opacity
      • Nodular corneal scar
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Causes

  • Demodex species specific to humans occupy 2 periocular sites hidden from external observation. They are small in size and possess the ability to move across the skin surface.
  • D folliculorum is found in hair and eyelash follicles associated with pilosebaceous glands in the eye or elsewhere on the face and the body. A single follicle may contain as many as 25 D folliculorum organisms.
  • D brevis leads a much more solitary lifestyle in sebaceous glands of the body and in the meibomian gland and the gland of Zeis.
  • D folliculorum measures 0.3-0.4 mm in length, whereas D brevis is one half the size of D folliculorum (0.15-0.2 mm) with similar structure of the head and the thorax but a shorter abdomen.
  • The 8 legs of this arachnid are segmented and provide locomotion at a rate of 8-16 mm/h.
  • D folliculorum and D brevis, also known as follicle mites, are believed to be more active in the dark, although capture in daylight is possible.
  • The bright light of the day and especially the biomicroscope cause the mite to recede back into the follicle. Therefore, the mite can be observed only when an epilated lash is observed under a low-power microscope.
  • The life stages of D folliculorum begin with copulation at the mouth of the follicle. Reproduction is believed to occur in darkness; a fact that is significant in symptomatology and treatment.
  • Following copulation, the female burrows back into the follicle near the opening of the pilosebaceous gland and lays her eggs.
  • Spickett reported the life cycle of D folliculorum and estimated that only 14.5 days elapse from ovum to adult stage, including 120 hours as an adult. Females may live an additional 5 days after oviposition.[3]
  • Sexes are separate; sexual maturity is reached in the larval form (neoteny).
  • Females are territorial; they remain in their respective follicles and wait for the nomadic philandering males that travel over the surface of the skin from one follicle to another in seek of females.
  • Adults reside in the follicle parallel to the hair shaft, head inward, often with the tail end (opisthosoma) protruding onto the surface of the skin at the base of the eyelash.
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Contributor Information and Disclosures
Author

Manolette R Roque, MD, MBA  General Manager, Full Partner, Ophthalmic Consultants Philippines Co.; President and CEO, Chief Refractive Surgeon, EYE REPUBLIC Ophthalmology Clinic; Section Chief, Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center; Section Chief, Ocular Immunology and Uveitis, International Eye Institute, St Luke's Medical Center Global City; Senior Eye Surgeon, The LASIK Surgery Clinic; Director, AMC Eye Center, Alabang Medical Center; President, Philippine Ocular Inflammation Society

Manolette R Roque, MD, MBA is a member of the following medical societies: American Academy of Ophthalmic Executives, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Administrators, American Uveitis Society, International Ocular Inflammation Society, Philippine Medical Association, Philippine Ocular Inflammation Society, and Philippine Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Barbara L Roque, MD  Full Partner, Ophthalmic Consultants Philippines Co; Service Chief, Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, Asian Hospital and Medical Center; Active Staff, International Eye Institute, St Luke's Medical Center Global City; Visiting Ophthalmologist, AMC Eye Center, Alabang Medical Center

Barbara L Roque, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Cataract and Refractive Surgery, Philippine Academy of Ophthalmology, Philippine Society of Cataract and Refractive Surgery, and Philippine Society of Pediatric Ophthalmolo

Disclosure: Nothing to disclose.

C Stephen Foster, MD, FACS, FACR, FAAO  Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution

C Stephen Foster, MD, FACS, FACR, FAAO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgments

The author was a fellow and affiliated with the Ocular Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, while performing this work.

References

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Illustration of Demodex folliculorum. Reprinted from BIODIDAC, Arthropoda Chelicerata Demodex, submitted by Livingstone, with permission from Antoine Morin, Biodidac, University of Ottawa.
Eyelid section shows Demodex folliculorum (M) in the hair follicle. Note mite mouthparts (arrow) embedded in epithelium and straplike layers of keratin (hematoxylin and eosin, X400). Reprinted from Am J Ophthal Vol. 91, English FP, Nutting WB, Demodicosis of Ophthalmic Concern, 362-372, 1981, with permission from Elsevier Science.
Section of sebaceous gland of an eyelash shows Demodex brevis (M). Note gland cell (C) destruction (McManus, X375). Reprinted from Am J Ophthal Vol. 91, English FP, Nutting WB, Demodicosis of Ophthalmic Concern, 362-372, 1981, with permission from Elsevier Science.
Cross-section through small hair follicle of the eyelid. Note distension, hyperplasia, and moderate epithelial keratinization caused by the activities of Demodex folliculorum (arrow) (hematoxylin and eosin, X375). Reprinted from Am J Ophthal Vol. 91, English FP, Nutting WB, Demodicosis of Ophthalmic Concern, 362-372, 1981, with permission from Elsevier Science.
Section of eyelid shows eyelash (L), cuffing (C), and small segment of Demodex folliculorum (M). Note layering of cuff (Masson, X275). Reprinted from Am J Ophthal Vol. 91, English FP, Nutting WB, Demodicosis of Ophthalmic Concern, 362-372, 1981, with permission from Elsevier Science.
Demodex folliculorum.
Demodex along the shaft of the cilia.
Demodex along the shaft of the cilia (higher magnification).
Backsides of numerous pubic crabs with infestation of the lashes and secondary blepharitis. Reprinted with permission from H.D. Riley, OD, Indiana University School of Optometry.
Phthiriasis (Phthirus pubis) pubic crab lash infestation and secondary blepharitis. Reprinted with permission from H.D. Riley, OD, Indiana University School of Optometry.
Phthiriasis (pubic lice). Reprinted with permission from H.D. Riley, OD, Indiana University School of Optometry.
 
 
 
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