J Korean Med Sci.  2011 Sep;26(9):1231-1237. 10.3346/jkms.2011.26.9.1231.

Clinical and Immunological Responses in Ocular Demodecosis

• Kim JH
• Chun YS
• Kim JC

• KMID: 1779400
• DOI: http://doi.org/10.3346/jkms.2011.26.9.1231

Abstract

The purpose of this study was to investigate clinical and immunological responses to Demodex on the ocular surface. Thirteen eyes in 10 patients with Demodex blepharitis and chronic ocular surface disorders were included in this study and treated by lid scrubbing with tea tree oil for the eradication of Demodex. We evaluated ocular surface manifestations and Demodex counts, and analyzed IL-1beta, IL-5, IL-7, IL-12, IL-13, IL-17, granulocyte colony-stimulating factor, and macrophage inflammatory protein-1beta in tear samples before and after the treatment. All patients exhibited ocular surface manifestations including corneal nodular opacity, peripheral corneal vascularization, refractory corneal erosion and infiltration, or chronic conjunctival inflammatory signs before treatment. After treatment, Demodex was nearly eradicated, tear concentrations of IL-1beta and IL-17 were significantly reduced and substantial clinical improvement was observed in all patients. In conclusion, we believe that Demodex plays an aggravating role in inflammatory ocular surface disorders.

Keyword

Blepharitis; Demodex; Immune Response; Ocular Surface; Tear Cytokine

MeSH Terms

Acari/drug effects/physiology
Adolescent
Adult
Aged
Animals
Blepharitis/drug therapy/*immunology/parasitology
Chemokine CCL4/analysis
Female
Granulocyte Colony-Stimulating Factor/analysis
Humans
Interleukin-12/analysis
Interleukin-13/analysis
Interleukin-17/analysis
Interleukin-1beta/analysis
Interleukin-5/analysis
Interleukin-7/analysis
Male
Middle Aged
Tea Tree Oil/therapeutic use
Tears/metabolism

Figure

• 

  Fig. 1 Representative microscopic photographs of Demodex folliculorum in patients with ocular demodecosis. Two D. folliculorum with an eyelash (A, arrows) and one free D. folliculorum are found in epilated eyelashes of patients.

• 

  Fig. 2 Clinical features of patients with ocular demodecosis (A, case 4; B, case 5; C, case 9; D, case 1; E, case 3; F, case 7; G, case 2; H, case 6; I, case 8). Large corneal nodular opacity (A-C), refractory corneal erosion and infiltration (D-F), peripheral corneal vascularization (C, G, H), and palpebral conjunctival papillary hypertrophy (I) are observed in patients with ocular demodecosis.

• 

  Fig. 3 Clinical appearance before and after lid scrubbing treatment with tea tree oil in patients with ocular demodecosis. (A and D, case 4; B and E, case 9; C and F, case 7). There are corneal nodular opacities (A, B), bulbar conjunctival injections (A, B) and central corneal infiltration (C) before the treatment. However, four weeks after the treatment, corneal opacities are markedly faded and conjunctival injections had resolved (D, E). Central corneal infiltration had also resolved (F).

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