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Demodex Patient Case #3


Amy Nau, DO, presents another case of Demodex in a female patient, highlighting the multifaceted approach required for successful treatment.

This is a video synopsis of a discussion involving Dr. Amy Nau, OD, Dipl CCLRT. The third case presented is about Emily, a 39-year-old white female referred by her habitual eye care provider for severe dry eye and contact lens fit issues. Emily expressed discomfort with medications, and her medical history included anxiety, depression, and celiac disease, while her ocular history noted high hyperopia (hypermetropia).

The examination revealed small palpebral apertures with heavy demodex infestation, two-plus lid margin telangiectasis, facial rosacea, significant meibomian gland atrophy, three-plus inferior SPK (superficial punctate keratitis), and corneal hyperalgesia. Emily's lifestyle factors, such as 12 hours of screen time, poor diet, dehydration, and vitamin D deficiency, contributed to her condition.

Despite multiple therapy refusals, including IPL (intense pulsed light) and tea tree oil, Emily adopted new lids with mineral oil, Manuka honey, moisture chamber glasses, and Systane Complete. Her treatment also included dietary improvements, increased hydration, Omega-3 with D, and impression-based scleral lenses. Despite these efforts, Emily remained resistant to several therapies, hindering her progress.

Dr. Nau emphasized the challenge of managing patients like Emily, stressing the importance of addressing lifestyle choices for successful treatment. Attempts to introduce light-based therapies were considered, with IPL recommended due to Emily's small eyes and the presence of rosacea. Additionally, lotilaner (XDEMVY), a novel treatment for Demodex, is highly effective in reducing the population of Demodex mites.

The ongoing challenge with Emily showcased the complexities of managing patients with multifactorial issues and the importance of addressing both ocular and lifestyle factors for effective dry eye management. Dr. Nau shared insights into the difficulty of treating patients who resist certain therapies, emphasizing the need for a holistic approach to achieve optimal outcomes.

Video synopsis is AI-generated and reviewed by Optometry Times® editorial staff.

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