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Demodicosis Clinical Presentation

  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Nov 05, 2015
 

History

Symptoms include ocular irritation, itching, and scaling of lids. Past ocular history may include recurrent failed treatment of blepharitis.

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Physical

Gross observation may reveal the following:

  • Lid thickening
  • Scaling of lids
  • Madarosis (loss of lashes)
  • Conjunctival inflammation
  • Meibomian gland dysfunction
  • Rosacea: The results of the study by Moravvej et al [6] conclude that the prevalence and the number of Demodex mites in rosacea patients are higher than in control subjects, supporting the pathogenic role of Demodex mites in rosacea.
  • Decreased vision

Slit-lamp findings are as follows:

  • Collar of tissue around the base of the eyelashes
  • Follicular distention
  • 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, FPAO 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

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

Disclosure: Nothing to disclose.

Coauthor(s)

C Stephen Foster, MD, FACS, FACR, FAAO, FARVO 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, FARVO 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, Sigma Xi

Disclosure: Nothing to disclose.

Barbara L Roque, MD, DPBO, FPAO Senior Partner, Roque Eye Clinic; Chief of Service, Pediatric Ophthalmology and Strabismus Section, Department of Ophthalmology, Asian Hospital and Medical Center; Active Consultant Staff, International Eye Institute, St Luke's Medical Center Global City

Barbara L Roque, MD, DPBO, FPAO 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 Society of Cataract and Refractive Surgery, Philippine Academy of Ophthalmology, Philippine Society of Pediatric Ophthalmolo

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Hospital

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

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.

Acknowledgements

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
  1. Coston TO. Demodex folliculorum blepharitis. Trans Am Ophthalmol Soc. 1967. 65:361-92. [Medline].

  2. Ayres S Jr. Demodex folliculorum as a pathogen. Cutis. 1986 Jun. 37(6):441. [Medline].

  3. Spickett SG. Studies on Demodex folliculorum, Simon (1842). I. Life history. Parasitology. May 1961. 51:181-192.

  4. Post DF, Juhlin E. Demodex folliculorum and blepharitis. Arch Dermatol. 1963. 88:298-302.

  5. Liang L, Safran S, Gao Y, Sheha H, Raju VK, Tseng SC. Ocular demodicosis as a potential cause of pediatric blepharoconjunctivitis. Cornea. 2010 Dec. 29(12):1386-91. [Medline].

  6. Moravvej H, Dehghan-Mangabadi M, Abbasian MR, Meshkat-Razavi G. Association of rosacea with demodicosis. Arch Iran Med. 2007 Apr. 10(2):199-203. [Medline].

  7. Kheirkhah A, Blanco G, Casas V, Tseng SC. Fluorescein dye improves microscopic evaluation and counting of demodex in blepharitis with cylindrical dandruff. Cornea. 2007 Jul. 26(6):697-700. [Medline].

  8. Celerio J, Fariza-Guttman E, Morales V. Pilocarpine as a coadjuvant treatment of blepharoconjunctivitis caused by Demodex folliculorum. Invest Ophthalmol Vis Sci. 1989. 30 (Suppl):40.

  9. Gao YY, Di Pascuale MA, Elizondo A, Tseng SC. Clinical treatment of ocular demodicosis by lid scrub with tea tree oil. Cornea. 2007 Feb. 26(2):136-43. [Medline].

  10. Lacey N, Kavanagh K, Tseng SC. Under the lash: Demodex mites in human diseases. Biochem (Lond). 2009 Aug 1. 31(4):2-6. [Medline]. [Full Text].

  11. Gao YY, Di Pascuale MA, Li W, Baradaran-Rafii A, Elizondo A, Kuo CL, et al. In vitro and in vivo killing of ocular Demodex by tea tree oil. Br J Ophthalmol. 2005 Nov. 89(11):1468-73. [Medline]. [Full Text].

  12. Gao YY, Xu DL, Huang lJ, Wang R, Tseng SC. Treatment of ocular itching associated with ocular demodicosis by 5% tea tree oil ointment. Cornea. 2012 Jan. 31(1):14-7. [Medline].

  13. Cliradex instructional video. Available at http://www.youtube.com/v/OljcnbghoR8?hl=en&fs=1.

  14. Beaver PC, Jung RC, Cupp EW. Clinical parasitology. Clinical Parasitology. 9th ed. Philadelphia, Lea & Febiger: 1984. 596.

  15. Forton F, Germaux MA, Brasseur T, De Liever A, Laporte M, Mathys C, et al. Demodicosis and rosacea: epidemiology and significance in daily dermatologic practice. J Am Acad Dermatol. 2005 Jan. 52(1):74-87. [Medline].

  16. Gao YY, Di Pascuale MA, Li W, Baradaran-Rafii A, Elizondo A, Kuo CL, et al. In vitro and in vivo killing of ocular Demodex by tea tree oil. Br J Ophthalmol. 2005 Nov. 89(11):1468-73. [Medline].

  17. Kheirkhah A, Casas V, Li W, Raju VK, Tseng SC. Corneal manifestations of ocular demodex infestation. Am J Ophthalmol. 2007 May. 143(5):743-749. [Medline].

  18. Cheng AM, Sheha H, Tseng SC. Recent advances on ocular Demodex infestation. Curr Opin Ophthalmol. 2015 Jul. 26 (4):295-300. [Medline].

  19. Hirsch-Hoffmann S, Kaufmann C, Bänninger PB, Thiel MA. Treatment options for demodex blepharitis: patient choice and efficacy. Klin Monbl Augenheilkd. 2015 Apr. 232 (4):384-7. [Medline].

  20. Filho PA, Hazarbassanov RM, Grisolia AB, Pazos HB, Kaiserman I, Gomes JÁ. The efficacy of oral ivermectin for the treatment of chronic blepharitis in patients tested positive for Demodex spp. Br J Ophthalmol. 2011 Jun. 95 (6):893-5. [Medline].

 
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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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