eMedicine Specialties > Ophthalmology > Infectious Disease

Demodicosis: Differential Diagnoses & Workup

Author: Manolette R Roque, MD, MBA, DPBO, FPAO, President and CEO, Chief of Service, Ocular Immunology and Uveitis, Consulting Staff, Cornea and Refractive Surgery, Eye Republic Ophthalmology Clinic; General Manager, Ophthalmic Consultants Philippines Co; Consulting Staff, CME Liaison, Section Chief of Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center
Coauthor(s): Barbara L Roque, MD, Full Partner, Ophthalmic Consultants Philippines Co, Chief of Service, Pediatric Ophthalmology and Strabismus, Consulting Staff, Orbit and Eye Plastics, EYE REPUBLIC Ophthalmology Clinic; 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
Contributor Information and Disclosures

Updated: Apr 7, 2008

Differential Diagnoses

Blepharitis, Adult
Chalazion
Dry Eye Syndrome
Hordeolum

Other Problems to Be Considered

Rosacea
Phthiriasis (pubic lice) of the lids
Meibomian gland dysfunction

Workup

Laboratory Studies

  • Diagnosis is made on a high index of clinical suspicion.
  • Occasionally, nasal skin scrapings may be requested to rule out the possibility of acne rosacea.

Imaging Studies

  • By visualizing the metazoan parasite under high-power magnification, a definitive diagnosis can be made.
  • An epilated lash examined under low-power magnification may demonstrate the organism.
  • Adding a fluorescein solution after mounting further helps in detecting and counting the mites that are embedded in cylindrical dandruff of epilated eyelashes.5
  • Electron microscopy has been used to visualize the organism.

Procedures

  • Slit lamp biomicroscopy

Histologic Findings

All reported histologic sections of lid follicles infested with D folliculorum show distention and thickening. Coston claims that fewer than one half of the specimens he observed showed perifollicular lymphocytic infiltration.1 Follicular inflammation produces edema and results in easier epilation of the eyelashes. It also affects cilia construction, and the lashes are observed to be more brittle in the presence of demodicosis. Dermal changes seldom extend beyond the perifollicular epidermal area, although epithelial hyperplasia associated with follicular plugging is often encountered.

More on Demodicosis

Overview: Demodicosis
Differential Diagnoses & Workup: Demodicosis
Treatment & Medication: Demodicosis
Follow-up: Demodicosis
Multimedia: Demodicosis
References
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References

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

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

  6. 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.

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  10. Barrio J, Lecona M, Hernanz JM, Sanchez M, Gurbindo MD, Lazaro P, et al. Rosacea-like demodicosis in an HIV-positive child. Dermatology. 1996;192(2):143-5. [Medline].

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

  12. Clifford CW, Fulk GW. Association of diabetes, lash loss, and Staphylococcus aureus with infestation of eyelids by Demodex folliculorum (Acari: Demodicidae). J Med Entomol. Jul 1990;27(4):467-70. [Medline].

  13. Crosti C, Menni S, Sala F, Piccinno R. Demodectic infestation of the pilosebaceous follicle. J Cutan Pathol. Aug 1983;10(4):257-61. [Medline].

  14. Damian D, Rogers M. Demodex infestation in a child with leukaemia: treatment with ivermectin and permethrin. Int J Dermatol. Sep 2003;42(9):724-6. [Medline].

  15. Demmler M, de Kaspar HM, Mohring C. Blepharitis. Demodex folliculorum, associated pathogen spectrum and specific therapy. Ophthalmologe. Mar 1997;94(3):191-6. [Medline].

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  21. 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. Nov 2005;89(11):1468-73. [Medline].

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  35. Zimmerman TJ, et al, eds. Textbook of Ocular Pharmacology. 1997.

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Further Reading

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Keywords

Demodex folliculorum, Demodex folliculorum longus, Demodex folliculorum brevis, Demodex folliculorum hominis, Demodex mites, follicle mites, blepharitis, common ectoparasites of the ocular adnexa, hair follicle mites

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Contributor Information and Disclosures

Author

Manolette R Roque, MD, MBA, DPBO, FPAO, President and CEO, Chief of Service, Ocular Immunology and Uveitis, Consulting Staff, Cornea and Refractive Surgery, Eye Republic Ophthalmology Clinic; General Manager, Ophthalmic Consultants Philippines Co; Consulting Staff, CME Liaison, Section Chief of Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center
Manolette R Roque, MD, MBA, DPBO, FPAO is a member of the following medical societies: American Academy of Ophthalmic Executives, 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, Chief of Service, Pediatric Ophthalmology and Strabismus, Consulting Staff, Orbit and Eye Plastics, EYE REPUBLIC Ophthalmology Clinic
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.

Medical Editor

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.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
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.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

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.

 
 
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