An edition of a clinical newspaper for optometrists – Helio.com/optometry’s Primary Care Optometry News features an article on the relationship between demodex infestation and ocular rosacea symptoms.
The web site appears to have broken formatting, so is difficult to read, but here are some extracts you may find interesting.
We know that the 3 main methods in treating ocular rosacea are to
- normalise tear film disturbance,
- control the bacterial overgrowth and also
- control inflammatory and hypersensitivity reactions.
Controlling the possible overgrowth of demodex mites may play a role in bringing ocular symptoms under control as part of a ocular rosacea beating regime.
Primary Care Optometry News, Volume 20, Number 11, November 2015. Michael D. Depaolis, Editor, by Abigail Sutton.
Demodex mites and rosacea have an unusual pathogen–disease relationship, one that is still being explored. According to Edward J. Wladis, MD, FACS, the association between Demodex and rosacea is not all that well-known.
“Demodex is both under-recognize and highly treatable. The problem is that we often fail to recognize the presence of Demodex until it’s pretty late in the game and patients are already suffering. However, with the proper treatment protocols, we can usually get the rosacea to quiet down and get patients feeling better,” Wladis told Primary Care Optometry News.
A variety of skin diseases can be caused by an imbalance in the immune mechanism, triggered by a high Demodex infestation, he said. Toll-like receptors, inflammation “The theory is that Demodex can stimulate a class of immunologic proteins called toll-like receptors,”
What to look for
Wladis said. “Our research has shown that patients with ocular rosacea have increased concentrations of these receptors in eyelid skin, and that these receptors seem to drive the inflammation that is associated with ocular rosacea.
“So, the presence of Demodex really adds gasoline to the fire,” he continued. “These patients have a tendency to develop an exuberant immune reaction, due to the prevalence of these restimulate them is present in increased quantities
Wladis offered tips on identifying Demodex. “A patient with cylindrical dandruff, clogged meibomian glands and the classic appearance of periocular inflammation likely has an infestation,” he said. “That presence needs to be addressed when developing a treatment strategy for the patient.”
Schachter recommends proper hygiene for the long term. As for treatment, tea tree oil therapy is toxic to the mites. “I refer to products that simply clean the lid margin as the janitor,” he said. “Tea tree oil is the terminator.” Tea tree oil is antibacterial, antifungal and anti-inflammatory and has acaricidal effects, he said. Gutierrez offered further treatment pearls.
“It is important that we properly instruct our patients on our prescribed treatment,” he said. “Have them clean their lashes, eyelids, eyebrows and skin around the orbit and nose, not just the eyelashes. Also remember, baby shampoo lid hygiene is ineffective in treating Demodex.”
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