The last few years have shown us, and colleagues in different corners of the world, that Demodex blepharitis is much more common than expected. The latest statistics show that this parasite is the cause of 45% of blepharitis in general, in people over 60 it is present in 84% of eyelid inflammations. Among young people with diabetes, acne rosacea or a compromised immune system, Demodex infection is the main cause of blepharitis.
Mites in Demodex species are found on the skin of the face, especially on the forehead, cheeks, sides sides of the nose, but also on the eyelids and eyelashes. In the surprisingly or not, these ectoparasites live almost permanently on the skin. human skin. In about 70% of cases, people infected with these mites are asymptomatic, i.e. show no signs or symptoms. This is also the main reason why many people live a lifetime with these parasites on their skin without knowing it. However, larger numbers of Demodex mites can cause undesirable symptoms and skin problems.
Demodex folliculorum has a length of 0.3-0.4 mm and is found in small hair follicles, especially on eyelashes. Both in its immature and adult stages, it feeds on skin cells. Demodex brevis is slightly smaller (0.15-0.2 mm) and is found in the glands which are connected to small hair follicles. Unlike Demodex folliculorum, Demodex brevis feeds on sebaceous gland cells. Both mites are senitransparent, almost invisible to the naked eye, but can be seen under a microscope.
Prin însăși prezența lor, acești paraziți produc modificări tisulare inflamatorii locale , cât și formarea unor dopuri foliculare cu înfundarea și atrofierea consecutivă a glandelor meibomiene responsabile de stabilitatea filmului lacrimal.
The symptoms that patients experience are multiple and non-specific: burning eyes, dryness, embarrassment eye discomfort, congestion. Localised itching sensation along the free edge of the eyelids, at the root of the eyelashes, can be an element of diagnostic guidance.
Prin examinarea la biomicroscop, se observă prezența unui manșon de detritus celular (coleretă) în jurul bazei genelor, semn clinic distinctiv și esențial pentru stabilirea diagnosticului. La acesta se adaugă semne nespecifice: edem și eritem palpebral, madaroza ( pierderea genelor), hiperemie conjunctivală, leziuni corneene.
Reviews optional, often unnecessary, examinations may be microscopy optical microscopy of a plucked eyelash (direct detection of the parasite) or confocal laser-scanning microscopy (CLSM)
Prin modificările produse la nivel local, prin prezența și activitatea sa, acest parazit induce o stare de inflamație constantă la nivelul segmentului anterior ocular, manifestată prin blefarită cronică, keratite sau conjunctivite repetate. Deseori leziunile provocate la nivel cornean sunt ireversibile și asociate cu un impact negativ asupra capacității vizuale. Se consideră că acarienii din specia Demodex reprezintă un ,,trigger’’ pentru diverse bacterii, motiv pentru care frecvența blefaroconjunctivitelor este mult crescută în cazul acestor pacienți. De asemenea, s-a demonstrat corelația dintre prezența acestui parazit și modificarea aspectului și funcționalității glandelor meibomiene, responsabile pentru stabilitatea filmului lacrimal ducând astfel la dezvoltarea chalazionului și progresia simptomatologiei specifice ochiului uscat.
Firstly, a thing to avoid is the application of corticosteroid ointments, which lead to increase the number of parasites.
Time-efficient, has proven to be tea tree oil, which is why at present there are multiple products (wipes, soaps, gels) based on tea tree oil used for eyelid hygiene.
In recent years, the treatment with intense pulsed light is considered to have a real effect on the development and multiplication of this parasite. According to the latest studies, this treatment has demonstrated an eradication rate of infection of about 83%, one month after the third treatment session. This IPL-based treatment is gaining ground in the treatment of this infection by increasing the local temperature above that supported by the parasite, without creating local adverse reactions in the skin.
Dr. Cristina Pac - Ophthalmologist
Each patient, each diagnosis has brought us closer and closer to performance! The medical team, carefully coordinated by Prof. Dr. Munteanu, is proud to offer the best ophthalmological services.
