OPT 539 Parasitic Lid Disease 2024 Notes PDF

12/2/2024 DEMODEX INFESTATION/DEMODICOSIS aka MITES Eyelid (also facial hair and eyebrow) mite infestation...

12/2/2024 DEMODEX INFESTATION/DEMODICOSIS aka MITES Eyelid (also facial hair and eyebrow) mite infestation Prevalence PARASITIC LID DISEASE – 0-25 years: 29% – 26-50 years: 53% Lorne Yudcovitch, O.D., M.S., F.A.A.O. – 51-90 years: 67% → ubiquitous OPT 539 Contributing factors – Mother-infant transmission (nursing) – Compromised immune system – Vector theory of spreading staph infection? Demodex infestation/Demodicosis Demodex Folliculorum Demodex folliculorum Cigar shaped (0.28 - 0.44 mm) Colonial (3+ per follicle) Upper section of hair follicle Collarettes/cuffs – Best clinical diagnostic sign Demodex brevis Shorter, stubbier species (0.16 - 0.21 mm) Solitary Sebaceous glands Damage/plugging of gland – Dry eye – Chalazion formation Demodex Folliculorum Demodex Lifecycle and Behavior Life cycle between 14 to 18 days Egg → larva → adult Female mites lay up to 10-12 eggs at a time Leads to overpopulation if unmanaged Demodex avoids light; buries head-first in follicles or glands, with only tail visible at follicle opening Lays eggs, ingests gland lining Results in follicular base distension and trichiasis Debris generated collects at lash roots Gelatinous cylindrical ‘sleeve’ or cylindrical dandruff at eyelash base (pathognomonic for mite infestation) LBY OPT 539 – Parasitic Lid Disease 1  12/2/2024 Gelatinous cylindrical dandruff sleeves https://contactlensupdate.com/2015/12/08 Triangular distension /demodex-folliculorum/ of follicle base Demodex infestation/Demodicosis Demodex Folliculorum Subjective Itching – especially in morning Burning Crusting Swelling of lid margins Lash loss Objective Lid margin erythema Conj. injection Blepharitis Cuffing around lashes Plugging of meibomian glands Lash loss = ___________ Chalazion Madarosis LBY OPT 539 – Parasitic Lid Disease 2  12/2/2024 Demodex infestation/Demodicosis Management Assessment/DDX Case HX Patient's age Clinical signs Plan/TX In-office procedure – aggressive lash scrubs Lid hygiene – Tea tree oil products may work Ung hs x 10-14 days (bland & viscous) Tea tree oil derived from leaves of Melaleuca alternifolia, an Australian tree Anti-microbial TX – for any super-infections Cliradex (Bio-Tissue) Ocusoft Oust Demodex Swabstix™ Natural, preservative-free lid, lash, facial cleanser “Utilizing a unique blend of all Has specific tea tree oil component (4-Terpineol) natural oils including tea tree – More potent miticidal than tea tree oil as a whole oil, sea buckthorn and – May reduce adverse/antagonistic effects coconut oil, Oust™ Demodex® of other components of tea tree oil Swabstix™ aid in the removal – Scientifically proven to eliminate Demodex of adult Demodex mites and Safe to use daily; eliminates signs and symptoms their offspring when used on Towelette qAM & qHS x 2 wks, then HS till no signs the skin and skin structures surrounding the eye.” Clean eyelids/margins/eyelashes/periocular area (Ocusoft) Keep eyes closed for 1 min while areas air dry Xdemvy Demodex treatment considerations Tarsus Pharmaceuticals Mites lifespan: 2-3 weeks lotilaner 0.25% ophth. sol. Female will lay about 20 eggs in single lash FDA approved July 2023 follicle in that time – Saturn-1 and Saturn 2 trials: Patients need several weeks (6-8 weeks in About 50% patients had some cases) of treatment and maintenance reduction to 2 or less collarettes, and about 60% Immunocompromised patients may retain patients had Demodex mites completely eradicated more mites and for longer time periods by 6 weeks – Mites may produce immunologic suppressants 1 drop both eyes twice daily (q12hr) for 6 weeks – More risk: older patients, diabetes, rosacea Sting/burn 10%; punctate keratitis/stye