Abstract
ObjectiveTo report the influence of Demodex folliculorum (D. folliculorum) infestation in patients with meibomian gland dysfunction (MGD) related dry eye and the associations of the infestation with MGD related dry eye.MethodsEyelashes (three from the upper eyelid and three from the lower eyelid) from 119 eyes of 119 patients diagnosed with MGD related dry eye were examined under a light microscope. There were 68 eyes of 68 patients with MGD related dry eye and D. folliculorum infestation (Demodex positive group) and 51 eyes of 51 patients without infestation (Demodex negative group). All patients completed an Ocular Surface Disease Index (OSDI) questionnaire and underwent tests for dry eye and MGD. The tests included fluorescein tear breakup time (TBUT), corneal fluorescein staining, Schirmer I test (SIT), lid margin abnormalities, meibum expression assessment, and meibomian gland dropout.ResultsThe scores for OSDI, corneal fluorescein staining, lid margin abnormalities, meibum expression, and meibomian gland dropout were significantly higher (all P < 0.05), while TBUT was significantly shorter in the Demodex positive group compared to the Demodex negative group (P = 0.020). The SIT values did not significantly differ between groups. Chalazion was significantly more prevalent in the Demodex positive group. The number of D. folliculorum was positively correlated with all three MGD parameters (P ≤ 0.035), OSDI; corneal fluorescein scores, and it was inversely correlated with BUT. The correlation for SIT was R2 = 0.075 (P = 0.064).ConclusionDemodex folliculorum infestation is possibly one of the key contributors in the pathogenesis of MGD related dry eye, and a higher prevalence of chalazion was found in D. folliculorum infected patients. The possible causal role of D. folliculorum infestation needs to be further studied.
Highlights
Demodex can have different effects on the ocular surface, including anterior blepharitis, posterior blepharitis accompanied by meibomian gland dysfunction (MGD), ocular rosacea, keratitis, and so on [1]
A total of 119 patients with MGD related dry eye who visited the Tongren Hospital were included in the study
Sixty-eight eyes of 68 dry eye patients with MGD accompanied by D. folliculorum infestation were enrolled in the Demodex positive group, and 51 eyes of 51 dry eye patients with MGD related dry eye alone were enrolled in the Demodex negative group
Summary
Demodex can have different effects on the ocular surface, including anterior blepharitis, posterior blepharitis accompanied by meibomian gland dysfunction (MGD), ocular rosacea, keratitis, and so on [1]. Demodex and MGD Related DED of the eyelashes as well as the lash follicles, while Demodex brevis (D. brevis) primarily infest the deeper sebaceous glands [2, 3]. Demodex folliculorum is more likely to cause anterior blepharitis with eyelash involvement while Demodex brevis may lead to posterior blepharitis more often, and the streptococci and staphylococci reside on the surface of the mites will lead to blepharitis both anteriorly and posteriorly [2, 3, 6]. The role of Demodex infestation in the pathogenesis of chronic blepharitis is still controversial [1, 3, 6]
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