Ocular Surface Disease Secondary To Palpebral And Facial Demodicosis

The paper presents the diagnostic pathway and outcomes of long-term treatment of blepharitis and secondary ocular surface inflammation in course of facial and palpebral demodicosis.

Department of Ophthalmology, University Clinical Centre of Medical University of Silesia in Katowice

Based on the retrospective medical record review, the diagnostic pathway and interdisciplinary approach to treatment of the facial and palpebral demodecosis has been analysed.

A patient ineffectively treated from years from facial papulopustules and erythema presented with blepharitis and significantly decreased visual acuity. On the first visit the best visual acuity (BCVA) of the right eye was 0,5 and of the left eye was 0,3. Slit lamp examination revealed inflammation of the eyelids margin with a cylindrical dandruff around the eyelash root, as well as superficial corneal vascularization and inflammation. After microscopic examination of the eyelashes, ocular demodecosis was confirmed. The targeted treatment was introduced.

After treatment the improvement in the condition of the eyelids and cornea was observed, along with improvement of BCVA, stabilization of the tear film on the ocular surface. After one year of observation the achieved BCVA was 1,0 in both eyes, corneal subepithelial hazes were almost invisible and the patient’s subjective complains have decreased significantly. After confirmation of the diagnosis of ocular demodicosis the patient was referred to a dermatologist with suspicion of facial demodicosis, which according to patient has never been suspected before. Facial skin scrapings confirmed the rosacea‐like demodicosis. Therefore the targeted treatment for this disease was introduced and after the treatment skin lesions improved.

Eyelid demodecosis may cause secondary inflammation of the eye surface and the cornea. Successful diagnosis and subsequent treatment of this entity which although can be a long-term process, finally leads to resolution of inflammation. Demodicosis often remains an interdisciplinary disease, which needs dermatologists and ophthalmologist cooperation as an incorrect diagnosis leads to the incorrect treatment, which often results in the exacerbation of skin lesions.