what is demodex blepharitis

Data on file. More study is needed. Any time we perform ocular surgerywhether cataract, refractive, glaucoma, oculoplastic, or any other ocular procedurewe want to set the patient up for success. Due to significant overlap with other anterior segment conditions, Demodex infestation remains underdiagnosed . It is caused by the demodex mite. Gao 2005b has also proposed a modified method for sampling and counting the Demodex mites that entails intentional selection of two lashes with cylindrical dandruff per eyelid, applying them to a coverslip, and counting the mites with a microscope while adding 100% alcohol to the slide to break up cylindrical dandruff. Photobiomodul Photomed Laser Surg. Two review authors independently assessed the risk of bias in included trials following the guidance described in Chapter 8 of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2017). The current review suggests that there is uncertainty related to the effectiveness of 5% to 50% tea tree oil for the shortterm treatment of Demodex blepharitis, though lower concentrations may be preferable in the eye care arena to avoid induced ocular irritation. In addition, 47% reported being conscious of their eyes all day, 23% were constantly worrying about their eyes, and 23% reported their eyes or eyelids having a negative appearance. Abstract 3546575. // +++ Set the default caption language +++ Our Terms of Use and Privacy Policy have changed. An official website of the United States government. We included six RCTs (Karakurt 2018; Koo 2012; Murphy 2018; {"type":"clinical-trial","attrs":{"text":"NCT01647217","term_id":"NCT01647217"}}NCT01647217; Wong 2019; Zhang 2019), among which five RCTs were included in one or more metaanalyses. } folliculorum':ti,ab,kw OR 'd. Schachter S, Yeu E, Holdbrook M, Baba S, Gomes PJ. This study aimed to understand the ability of tea tree oil to improve symptoms or to treat Demodex blepharitis (or both) in comparison to no treatment or other forms of treatment containing no tea tree oil. Gao YY, Di Pascuale MA, Li W, Liu DT, Baradaran-Rafii A, Elizondo A, et al. Fortune and Fortune Media IP Limited are not affiliated with, and do not endorse the products or services of, Tarsus. The first treatment for blepharitis is placing a warm compress on the affected eyelid several times a day. Blepharitis usually affects both eyes. We examined statistical heterogeneity using forest plots and the I statistic (Deeks 2017). Blepharitis - National Eye Institute | National Eye Institute About 84% of people 60 years or older have Demodex infestation, as do 100% of patients 70 years or older.2 Younger patients have Demodex overpopulation as well, particularly those with MGD and keratitis.3 The higher incidence in older populations is not well understood. (Photos courtesy of Laura M. Periman, MD). Primary: reduction in mite count after treatment compared to the baseline data. The most common justification for excluding children was the low prevalence of Demodex mites in younger people (Coston 1967; Herron 2005). Murphy 2018 compared Dr. Organic Tea Tree Face Wash containing 38% terpinen4ol daily at night for four weeks, OcuSoft Lid Scrub Plus containing 0.5% 1,2octanediol at night for four weeks, and one inclinic microblepharoexfoliation treatment at baseline visit using BlephEx. Risk of bias summary: review authors' judgments about each risk of bias item for each included study. A Primer on Demodex Blepharitis - Modern Optometry approximately six weeks) in order to ensure the adequate killing of the parasite (Cheng 2015). Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, et al. Methods Online surveys were administered using scaled,. Final approval of the document to be published: KS, ADP, JTL. Unfortunately, this systematic review was only able to recover six studies, most of which had a high degree of bias. Murphy 2018 had three intervention groups: the participants were aware of the treatment they were receiving in all three groups. We planned to address missing study data for the outcomes of interest or any unclear information by writing to study investigators. All rights reserved. For long-term efficacy, therapeutic choices are focused on the underlying cause or causes of the problem. We considered the consistency of the effect estimates. The other two described a total of six participants randomized to treatment with tea tree oil who experienced ocular irritation or discomfort that resolved with reeducating the patient on application techniques and continuing use of the tea tree oil. Part of that is addressing any potential sources of infection, inflammation, and ocular surface disease that could complicate the postoperative course. Three RCTs provided information on adverse events. There was a high and unclear risk of bias in all the RCTs as the participants or personnel were not masked to the intervention, with Koo 2012 being the only trial that mentioned masking of the outcomes assessor. Blepharitis is an inflammation of the eyelids in which they become red, irritated and itchy with dandruff-like scales that form on the eyelashes. Koo 2012 enrolled participants between 2009 and 2011. } else { We recognized that the unit of analysis is the eyelash for some outcomes and the individual participant for others, and we, therefore, exercised caution when extracting the data and summarized any unit of analysis issues that we encountered. Blepharitis caused by seborrheic dermatitis, rosacea or other diseases might be controlled by treating the underlying disease. {"type":"clinical-trial","attrs":{"text":"NCT01647217","term_id":"NCT01647217"}}NCT01647217 reported no adverse events. Bitton 2019 performed a systematic review of general eyelid hygiene products, though there was no metaanalysis performed, both RCTs and nonRCTs were included, products beyond tea tree oil were studied, and studies included those that were not focused on treating Demodex blepharitis. browser_language = browser_language.substr(0, 2); She has been actively involved in writing blogs in field of health and wellness. Yeu E, Holdbrook M, Baba S, Gomes PJ. Demodex infestation on the face has been implicated in causing rosacea (Fig.1A). {"type":"clinical-trial","attrs":{"text":"NCT01647217","term_id":"NCT01647217"}}NCT01647217 compared pads with terpinen4ol one or two times per day for six weeks with placebo pads one or two times per day for six weeks. Determining that terpinen4ol alone has high antiparasitic properties at a 1% concentration is an essential finding because higher concentrations of tea tree oil have been associated with ocular irritation and high concentrations of oxidation products have been associated with allergic reactions, which are the primary adverse effects associated with tea tree oil treatment (Hammer 2006). The inclusion criteria for all included studies was a clinical diagnosis of ocular demodicosis/Demodex blepharitis. Murphy 2018, however, did not report individual group findings. Three RCTs (318 participants) reported information for adverse events. Fluorescein dye improves microscopic evaluation and counting of demodex in blepharitis with cylindrical dandruff. Tea tree oil therapies may be more effective as they are known to have antibacterial, antifungal, and antiinflammatory properties (Liu 2010). Basta-Juzbasic A, Subic JS, Ljubojevic S. Demodex folliculorum in development of dermatitis rosaceiformis steroidica and rosacea-related diseases. Mean differences in these studies ranged from 10.54 (95% CI 24.19, 3.11) to 3.40 (95% CI 0.70 7.50). While other forms of treatment, such as intense pulsed light treatment, also show some promising results (Zhang 2019), tea tree oil appears to be one of the most commonly prescribed and effective means for treating Demodex blepharitis. Ian Benjamin Gaddie, Eric D. Donnenfeld, Paul Karpecki, John Meyer, Elizabeth Yeu, Saturn II Study Group. Corneal manifestations of ocular demodex infestation. {"type":"clinical-trial","attrs":{"text":"NCT01647217","term_id":"NCT01647217"}}, 1.1 Mean change in (or mean) number of Demodex mites per 8 eyelash, 1.2 Mean change in (or mean) participantreported change in symptoms, 1.3 Proportion of participants eradicated of mites (posthoc addition), 1.4 Patient compliance as defined by investigators (posthoc addition), {"type":"clinical-trial","attrs":{"text":"NCT01073150","term_id":"NCT01073150"}}, {"type":"clinical-trial","attrs":{"text":"NCT03422146","term_id":"NCT03422146"}}, Evaluation of the efficacy of tea tree oil on the density of Demodex mites (Acari: Demodicidae) and ocular symptoms in patients with demodectic blepharitis. Judgment comment: authors did not discuss the sequence generation method. To prepare a patient with Demodex infestation for surgery, I usually use a combination of mechanical and chemical methods to remove collarettes, kill mites, and enhance skin barrier function in the patient. The six included RCTs compared some form of tea tree oil intervention and application regimen with another Demodex blepharitis treatment or no treatment. Am J Ophthalmol 2007;143:743-749. This site is intended for healthcare professionals only, Twice-daily lotilaner ophthalmic solution effective treatment of patients with Demodex blepharitis, CDSCO (Central Drugs Standard Control Organisation) News, https://doi.org/10.1016/j.ophtha.2023.05.030. We assigned each item as having 'low risk,' 'high risk,' or, if the information provided was insufficient to make an assessment, 'unclear risk.' Keeping Blepharitis Under Control It is very important to keep your eyelids, skin and hair clean. var track_language; The Ultimate Guide to Demodex Blepharitis - Eyes On Eyecare Generally, significant Demodex infestation results in significant inflammation. We assessed the certainty of the evidence using the GRADE approach with GRADEpro GDT software (GRADEpro GDT). In severe cases of Demodex, ivermectin can be prescribed orally or topically (Soolantra; Galderma) to control the facial Demodex burden. Participants were both men and women with a mean age of 39 to 55 years when reported. High prevalence of ocular demodex in lashes with cylindrical dandruffs. Warm compresses: Take a wash cloth and run it under warm water. TTO purchased from Essential Oil Company (Portland, OR) was mixed with petroleum jelly to 5% (vol/vol) TTO in a sterile hood, lid massage with 5% TTO 15 minutes a day. The electronic databases were last searched on 18 June 2019. Heacock CE. inclusion/exclusion criteria), underlying disease conditions, and medical history; interventions (e.g. Participantreported change in symptoms was reported in the paper as mean in participantreported change in symptoms (OSDI scores) at 1 month. The literature reports a range of scales for grading Demodex blepharitis severity. This review was supported by the NIHR, via Cochrane Infrastructure funding to the CEV UK editorial base. As reported,12,13patients receiving 50% TTO lid scrub show dramatic improvements in symptoms, ocular surface inflammation, lipid tear film stability, corneal epithelial smoothness, and visual acuity (Fig. No serious adverse events were reported, with no discontinuations due to adverse events. Lid 'n Lash Hygiene, a nonprescription eyelid wipe, without any medicinal ingredients. 2A),12corneal vascularization, infiltration, superficial opacities, and nodular scarring (Fig. LianBio Completes Enrollment in Pivotal Phase 3 LIBRA Trial - GlobeNewswire ", Blinding of outcome assessment (detection bias). Sadri E, Yeu E, Trattler W, Holdbrook M, Baba S. The prevalence of collarettes and Demodex blepharitis in ophthalmology and optometry practices. 26 Jun 2023 14:32:47 Monday - Friday 8:00 am - 5:00 pm. For Murphy 2018, we only considered the data from the participants who were demodex positive within the two arms comparing lid scrubbing with and without tea tree oil. Study reveals impact of Demodex blepharitis - Healio: Medical News Wong 2019 reported using Graphpad software for random sequence generation; we considered this method to have a low risk of bias. Other treatment options, such as using intense pulsed light might unclog the glands. TTO (tea tree certified organic, Sydney Oil Co, Sydney, Australia) diluted with mineral oil into different concentrations. track_language = tracks[i].language.substr(0, 2); for (var i = 0; i < (tracks.length); i++) { This review is, therefore, important because it summarizes the current understanding of the use of tea tree oil for treating ocular Demodex infestations along with the clinical trials that either support or refute the clinical utility of tea tree oil. Zhang 2019 compared daily 5% tea tree oil lid massage for 15 minutes with inclinic intense pulsed light treatment for 90 days delivered at 30, 60, and 90 days. If a collarette is not present, a random eyelash should be selected (Murphy 2020). Intolerant Patients Basta-Juzbasic A, Subic JS, Ljubojevic S. Demodex folliculorum in development of dermatitis rosaceiformis steroidica and rosacea-related diseases. We prepared a 'summary of findings' table for the seven outcomes prespecified in our protocol (Savla 2019). There were minor deviations from the published protocol that included the posthoc addition of two outcomes: proportion of participants eradicated of Demodex mites and patient compliance with treatment. 2019;13:1493-1497. doi:10.2147/OPTH.S209067, Comparing efficacy of different antibiotics as POE prophylaxis in cataract surgery, Podcast: Talking about the anterior segment pipeline for 2023, The importance of ocular health prior to cataract and refractive surgery, Cosmetic surgery of the cornea: A new type of surgery, Cigna expands coverage of glaucoma surgical procedures to include canaloplasty and goniotomy, Dietary supplement can improve measurable visual outcomes, Treating vitreous opacities with YAG laser vitreolysis, Leber hereditary optic neuropathy: Outlining diseases natural course, Treating Demodex blepharitis efficiently before surgery. Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, et al. ChiCTR1800019466, ChiCTROON16010205, and Maher 2018 were not RCTs. The multicenter observational study included 311 patients who were screened for Demodex blepharitis and had three objective signs of the disease: the presence of Demodex mites, the presence of collarettes on the lashes and lid margin erythema. One RCT (135 participants) reported a subjective mean score for cylindrical dandruff and eye redness before and after the intervention (Karakurt 2018). The literature suggests that tea tree oil (primary active ingredient terpinen4ol) is a promising treatment of Demodex blepharitis (Tighe 2013). Except for one trial (Wong 2019), all the other trials were at high or unclear risk for the method for random sequence generation or the method for allocation concealment. Judgment comment: randomization method not described. Judgment comment: information available only as trial registry record. We do tell the patient that most of these things, including death, are exceedingly rare, however, in the interest of full disclosure, we list everything that is possible. 2018;102(8):1098-1102. doi:10.1136/bjophthalmol-2017-310302, 4. Judgment comment: all 20 participants completed the study. It is uncertain if tea tree oil (concentration ranging from 5% to 50%) is helpful for reducing the number of Demodex mites in people with Demodex blepharitis in shortterm cases. Coston 1967 suggests that six or more Demodex mites per 16 lashes are clinically significant, while Biernat 2018 suggests that the presence of one Demodex mite, larva, or egg is clinically significant. You can also gently massage the oil glands during this time to clear any blockages. Twice-daily treatment with lotilaner ophthalmic solution,holds promise for the effective treatment of patients with Demodex blepharitis suggests a new study published in the Opthalmology. In the absence of considerable clinical and methodological heterogeneity, we used a randomeffects model to compute a quantitative synthesis. For two of the RCTs (Wong 2019; Zhang 2019), the participants were aware of the intervention they were receiving, and only the investigators were masked. Pathogenic role of Demodex mites in blepharitis. Learn about who we are, how we do things, and the people who lead us. Monitoring Editor: Cochrane Eyes and Vision Group, Cochrane Central Register of Controlled Trials (CENTRAL; 2019; Issue 6) (which contains the Cochrane Eyes and Vision Trials Register) in the Cochrane Library (searched 18 June 2019) (, Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to 18 June 2019) (, US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (www.clinicaltrials.gov; searched 18 June 2019) (, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp; searched 18 June 2019) (, Standard methods for accurate diagnosis and classifying the severity of Demodex blepharitis (. Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment, Tea tree oil exhibits antifungal activity against Botrytis cinerea by affecting mitochondria. When present, collarettes are easily seen along the lash line of the upper lid margin when your patient looks down. Most of the other studies excluded participants using other forms of treatments for Demodex mites or having other ocular or systemic diseases. We did not need to contact trial authors to clarify any details needed to make a complete assessment of eligibility. {"type":"clinical-trial","attrs":{"text":"NCT01647217","term_id":"NCT01647217"}}NCT01647217 reported zero adverse events. The authors noted that mean habitual LogMAR visual acuity for all study participants improved posttreatment (mean LogMAR 1.16, standard deviation 0.26 at 4 weeks). At Day 43, the study group achieved a statistically significant (p<0.0001) higher proportion of patients with collarette cure (56.0% vs 12.5%), clinically meaningful collarette reduction to 10 collarettes (89.1% vs 33.0%), mite eradication (51.8% vs 14.6%), erythema cure (31.1% vs 9.0%), and composite cure (19.2% vs 4.0%) than the control group. We evaluated three RCTs (Karakurt 2018; Koo 2012; Murphy 2018) at unclear risk of bias as there was no published protocol to assess if all outcomes had been reported. But Demodex can multiply too quickly in people who are immunocompromised or have other skin conditions. "Cylindrical dandruff" and associated Demodex infestation is often a neglected entity. Posterior blepharitis affects the inner eyelid near the eye. Recalcitrant, multifactorial, dry eye commonly occurs in people with ocular Demodex infestations (Cheng 2015; Post 1963). Although tea tree oil likely has multiple modes of action and likely contains multiple molecular species with antimicrobial properties, since it has action against bacteria, fungus, and parasites (Cheng 2015; Li 2017; Schelz 2006), terpinen4ol is the most active tea tree oil molecular compound against Demodex mites (Tighe 2013). HHS Vulnerability Disclosure, Help Please reach out to us using the form below. We observed statistical heterogeneity suggesting methodological or clinical differences between the studies included in the metaanalysis. Other times, blepharitis may result from an over-population of microscopic mites, known as Demodex, living inside the eyelash follicles. Accessibility Blepharitis is classified into two types. Cleansing towelettes with 4-terpineol isolate (Cliradex; Bio-Tissue), the miticidal component of tea tree oil, have the highest antidemodectic activity of all the commercial cleansers.5 Related: The role of IPL in OSD treatmentPatients use the towelettes to clean the eyelids, lashes, and face. WHAT IS DEMODEX BLEPHARITIS? For continuous outcomes, when the mean change from baseline was not available, we used mean difference (MD) at a followup time point instead. ". Demodex mites are associated with over 2/3 of blepharitis cases in the US, which are characterized by eyelid inflammation, redness, and irritation.2,4. Twice-daily treatment with lotilaner ophthalmic solution, 0.25% for 6 weeks was generally safe and well tolerated and met the primary endpoint and all secondary endpoints for the treatment of Demodex blepharitis compared to the vehicle control. Gao and colleagues also suggest that if no cylindrical dandruff is observed, mites can still be searched for by collecting lashes as described above, adding saline to the slide instead of 100% alcohol because cylindrical dandruff will not need to be degraded. A review of the toxicity of Melaleuca alternifolia (tea tree) oil. Of all the treatments investigated, tea tree oil is the most promising option for killing Demodex mites (Liu 2010). exp Meibomian Glands/8. Karakurt 2018 and {"type":"clinical-trial","attrs":{"text":"NCT01647217","term_id":"NCT01647217"}}NCT01647217 required participants to have had a previous diagnosis of Demodex blepharitis and regular followups since being diagnosed with the condition. Most studies included in this report had a high degree of bias. Zhang 2019 and {"type":"clinical-trial","attrs":{"text":"NCT01647217","term_id":"NCT01647217"}}NCT01647217 only reported end of the month interaction with the participants. Judgment comment: all outcomes in the methods were reported; however, they did not have a prepublished protocol, so it is unclear if they selectively reported data. The examiner should then select an eyelash with a collarette (Murphy 2020). Demodex infestation on the face has been implicated in causing rosacea (Fig.1A).1-5In the eyelids, Demodex infestation gives rise to blepharitis.6-9Such blepharitis is frequently associated with mite-harboring cylindrical dandruff in eyelashes (Fig.1B).10Demodex folliculorum tends to be clustered to the root of the lashes (Fig. A third review author resolved any conflicts at all stages. Among other things, it details "every complication known to man," stating that "problems listed can occur, but are not limited to the following " and then listing every complication that could possibly occur! We planned to consider a subgroup analysis by severity (mild versus moderate, as defined by study investigators) of Demodex infestation. Demodex is a type of mite that lives in human hair follicles, usually on your face. Cornea 2007;26:136-143. For, One multiarm study reported data on visual acuity, but it did not provide individual group findings. None of the studies addressed this outcome as defined. Two RCTs (Wong 2019; Zhang 2019) were at low risk of bias as all the outcomes specified in the protocol had been reported.

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