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Milton Hom, OD, FAAO, discussed diagnosis and treatment of the mite Demodex at the American Academy of Optometry’s annual meeting in Seattle.
Seattle-Milton Hom, OD, FAAO, discussed diagnosis and treatment of the mite Demodex at the American Academy of Optometry’s annual meeting in Seattle.
Demodex are found in 100% of patients 70+ years of age, and mite density rises in the sixth decade of life.
The clinical sequence includes:
• Clinical history, including blepharitis, dry eye, or ocular allergy;
• Slit-lamp examination, looking specifically for cylindrical dandruff;
• Microscopic confirmation of Demodex, including counting of eggs, larvae, and adults;
Patients with an overinfestation of Demodex exhibit symptoms of itch, burning, foreign body sensation, crusting, redness, and blurry vision. Some 85% of patients with Demodex also have meibomian gland dysfunction.
Cylindrical dandruff is a hallmark of Demodex. About 12.9 mites per patients were found with signs of cylindrical dandruff, in contrast to 0.35 mites per patient without.
Rosacea patients have a 7 to 8 times higher incidence of Demodex. “If you see rosacea and no Demodex, you’re missing it,” says Dr. Hom.
In-office treatments include lid scrubs, tea tree oil, and use of a bleph brush. Patients need to return for several treatments over the course of several weeks and add a home regimen. Suggest use of tea tree oil shampoo and soap to patients with an infestation of Demodex. Remember that everyone has some Demodex; we just try to control the numbers when they get out of hand.
• Tea tree oil pads are sometimes dry on one side, so squeeze the pad so both sides are wet.
• Don’t forget children…kids can have large Demodex populations as well as adults.
• Mites are frequently mistaken for allergy.
• When epilating lashes, look for cylindrical dandruff at the base of the lash, and look for “sick” lashes (short, discolored, misdirected).
Dr. Hom’s banned list for Demodex control:
• Emulsion drops;
• Restasis (cyclosporine, Allergan);
• Prostaglandins (these stimulate mite counts);
• Latisse (bimatoprost, Allergan);
• Antibiotics (useless in controlling mite population).