Mite Induced Conjunctival Nodule

To describe a case of unilateral palpebral conjunctival nodule due to Demodex brevis infestation

Urban private practice setting in India

A 45-year-old male presented to us with complains of redness and irritation in his left eye with swelling and drooping of his upper eye lid since the past 4 months. He gave a past history of recurrent lid swellings involving both eyes since last 8 years. His best corrected visual acuity with his existing glasses was 6/6, N6 in both eyes. Slit-lamp evaluation of the left eye revealed discharge, and conjunctival congestion. An elevated, nodular lesion of size 5 mm x 3.8 mm was noted on his left upper tarsal conjunctiva. The remaining tarsal conjunctiva demonstrated diffuse papillary congestion. Left lower lid demonstrated presence of chalazion. Cortical cataract was also noted in both eyes. Rest of the ocular examination was within normal limits. Eyelash epilation and microscopy from both eyes revealed presence of Demodex brevis. A diagnosis of Demodex induced conjunctival nodule was made.  He was started on weekly lid scrubs with 50% Tea Tree Oil at the clinic along with daily lid massage with 15% Tea Tree Oil (TTO) at home. 

Gradual reduction in lesion size was noted over next four weeks. The weekly sessions were stopped after four weeks and patient was asked to continue daily lid massage with 15% TTO. Eight weeks later, minimal increase in lesion size with increased papillary congestion was noted. Weekly lid scrubs with 50% TTO was resumed and continued for another six weeks and stopped. Patient was asked to continue daily lid massage with 15% TTO for 2 months. At the final follow-up, one year after his initial presentation, complete resolution of the nodule with no recurrence was noted. TO conclude, long standing Demodex infestation can rarely present as conjunctival nodule. Such lesions can be treated conservatively with Tea Tree Oil lid scrubs