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Multiple Eyelid Signs are Suggestive of Demodex Infestation

Authors Udomwech L, Phasuk N

Received 18 December 2020

Accepted for publication 3 February 2021

Published 17 February 2021 Volume 2021:15 Pages 671—678


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Lunla Udomwech, Nonthapan Phasuk

School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand

Correspondence: Lunla Udomwech
School of Medicine, Walailak University, 222 Thaiburi, Tha Sala, Nakhon Si Thammarat, 80160, Thailand
Tel +6675 672 801
Fax +6675 672 807

Purpose: To determine the signs associated with Demodex infestation in blepharitis patients and the rates of eyelash Demodex colonization among blepharitic patients and healthy individuals in Thailand.
Patients and Methods: This was a prospective, case–control clinical study. Eighty-three controls and 43 blepharitic patients were consecutively enrolled from Walailak University Hospital. Each patient answered a questionnaire, underwent a complete eye exam, and had four lashes from each eye epilated; eyelashes were directly examined under a light microscope. Ocular signs, including types of eyelash debris (waxy debris, scaly debris, or cylindrical dandruff (CD)), erythema and telangiectasia of the eyelid, were noted.
Results: Demodex infestation was observed more frequently among patients with blepharitis than among controls (67.4% in the blepharitis group, 26.5% in the control group, p-value < 0.001). The participants with Demodex infestation were 5.7 times more likely to have blepharitis than the controls (odds ratio 5.74; 95% confidence interval 2.57– 12.82, p-value < 0.001). Clinical signs that were significantly (p-value < 0.05) related to demodicosis were lid erythema, lid telangiectasia, and any type of eyelash debris (scaly, waxy, or CD).
Conclusion: In contrast to previous studies that found only CD to be highly associated with eyelash demodicosis, we found multiple suggestive signs: any kind of debris on eyelashes (scaly, waxy, or CD), eyelid erythema, and eyelid telangiectasia. Approximately one-quarter (26.5%) of the studied population had asymptomatic mite colonization. Demodex infestation should therefore always be on the list of possible etiologies when treating patients with blepharitis or other ocular surface-related problems.

Keywords: Demodex, blepharitis, eyelid signs, debris, Thailand

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