Abstract
PurposeTo compare existing and novel diagnostic techniques for confirming ocular Demodex infestation and to recommend the most reliable method for routine use by eye care practitioners, based on yield and clinical applicability. MethodsFifteen participants with a prior Demodex blepharitis diagnosis or featuring typical cylindrical dandruff (CD) collarettes, and seven healthy controls were enrolled. Demodex presence was assessed using five techniques, applied consecutively, on a minimum of two different eyelashes on each eyelid of every participant, for each test, in situ: 1. using fine-point forceps and 25-40x biomicroscopy magnification, by eyelash rotation as proposed by Mastrota (ROT); 2. by removing cylindrical dandruff and exposing the eyelash insertion point at the lid margin (CDR); and 3. by laterally tensioning the eyelash (LET) following CDR. The typical appearance of cigar-shaped mite tails protruding from each assessed eyelash follicle was observed, and mite tails counted and averaged per participant for each assessment technique. 4. Lash epilation, and mite presence evaluated using bright-field microscopy at 10-40x magnification (EPI). 5. Finally, eyelash follicles were imaged using in vivo confocal microscopy (IVCM) and the images visually inspected for mite presence. ResultsIn the Demodex group, the highest numbers of mites/eyelash were identified by LET (3.8 ± 1.4), versus CDR (2.4 ± 1.6) and ROT (1.1 ± 1.2), alone (all p < 0.002). An average of 1.0 ± 0.8 mites/lash was identified by EPI. IVCM failed to offer unequivocal evidence of Demodex presence even in confimed cases. ConclusionsA novel technique for the clinical diagnosis and grading of Demodex in situ is described. By removing cylindrical dandruff and applying static, lateral tension to the eyelash without epilation, large numbers of mites are visible at the exposed eyelash follicle. The proposed method is convenient and clinically applicable, requiring only forceps and 25-40x biomicroscope magnification, and allowing rapid, efficient evaluation of large numbers of eyelashes.
Highlights
Demodex mites commonly reside in the sebaceous glands of the scalp, face, ears, and in the meibomian glands and eyelash follicles [1]
Eyelash follicles were imaged using in vivo confocal microscopy (IVCM) and the images visually inspected for mite presence
There were no significant differences in symptoms or tear film signs in those with and without signs of Demodex blepharitis (Table 1)
Summary
Demodex mites commonly reside in the sebaceous glands of the scalp, face, ears, and in the meibomian glands and eyelash follicles [1]. In the clinical setting, repeated eyelash removal (e.g. for monitoring treatment efficacy) is uncomfortable and naturally undesirable to patients, and the time commitment and need for laboratory equipment (such as a 100-200x magnification light microscope, pipettes etc.) limits widespread integration of this technique into standard clinical care. Proposed diagnostic alternatives for easier assessment and better patient comfort include a technique by which an eyelash is rotated around its own axis using forceps [13]. This motion reportedly “cores” Demodex from within the eyelash follicle, revealing mite tails at the insertion point of the lash. This study compares established and adapted techniques with the aim of optimising Demodex diagnosis in the clinical setting
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