Læknablaðið - 01.05.2016, Blaðsíða 27

LÆKNAblaðið 2016/102 235
unum og sjást þau best við að minnsta kosti 25x stækkun.5 Sívaln-
ingslaga hrúður við rót augnháranna (mynd 1) er einkennandi
fyrir Demodex-hvarmabólgu.17 Mítlarnir dvelja í hársekkjum augn-
háranna og sjást einungis að litlu leyti utan þeirra. Með því að toga
varlega með töng í augnhár og snúa því eins og skeið væri snúið
eftir innra byrði skálar eru mítlarnir hraktir út í op hársekksins og
verða þannig sjáanlegir.11,14
Þessi tvö tilfelli sýndu bata eftir mítlameðferð og lýstu ákveðn-
um létti þar sem kláði minnkaði til muna eða hvarf. Augnhár
litu mun betur út og OSDI-spurningalistinn staðfesti betri líðan.
Hvarmabólga af völdum Demodex er vangreind þó tilvist hennar
hafi verið þekkt í fjöldamörg ár. Þar af leiðandi er mikilvægt að
leita eftir Demodex-mítlum þegar hrúður sést á augnhárum og ef
hefðbundin meðferð hefur ekki gagnast nægjanlega.
Að lokum má minnast þess sem Coston skrifaði árið 1967:18
„Consider the scrambling of this microscopic octopoded mob
while the host sleeps: males seeking, finding, breeding females;
gravid females seeking new follicles; inhabitants of follicles
sweeping feces outside.“
Þakkir
Dr. Halldór Pálmar Halldórsson, líffræðingur hjá Rannsóknar-
setri HÍ á Suðurnesjum, fyrir ráðleggingar vegna sýnatöku og
framkvæmd hennar.
Heimildir
1. 2007 Report of the International Dry Eye WorkShop
(DEWS). Ocul Surf 2007; 5: 75-107.
2. Hom MM, Mastrota KM, Schachter SE. Demodex: Clinical
cases and diagnostic protocol. Optom Vis Sci 2013; 90:
e198-205.
3. Milosevic MA, Frank LA, Brahmbhatt RA, Kania SA. PCR
amplification and DNA sequencing of Demodex injai from
otic secretions of a dog. Vet Dermatol 2013; 24: 286-e66.
4. Tighe S, Gao YY, Tseng SC. Terpinen-4-ol is the Most
Active Ingredient of Tea Tree Oil to Kill Mites. Transl Vis
Sci Technol 2013; 2: 2.
5. Liu J, Sheha H, Tseng SC. Pathogenic role of Demodex
mites in blepharitis. Curr Opin Allergy Clin Immunol
2010; 10: 505-10.
6. Rufli T, Mumcuoglu Y. The hair follicle mites Demodex
folliculorum and Demodex brevis: biology and medical
importance. A review. Dermatologica 1981; 162: 1-11.
7. Desch CE. Human hair follicle mites and forensic
acarology. Exp Appl Acarol 2009; 49: 143-6.
8. Rather PA, Hassan I. Human demodex mite: the versatile
mite of dermatological importance. Indian J Dermatol
2014; 59: 60-6.
9. Desch C, Nutting WB. Demodex folliculorum (Simon) and
D. brevis akbulatova of man: redescription and reevalu-
ation. J Parasitol 1972; 58: 169-77.
10. Elston CA, Elston DM. Demodex mites. Clin Dermatol
2014; 32: 739-43.
11. Mastrota KM. Method to identify Demodex in the eyelash
follicle without epilation. Optom Vis Sci 2013; 90: e172-4.
12. Bruenech JT, Haugen I-BK. Tørt øye og parasitten
Demodex. Scand J Optometry Vis Sci 2014; 7: 1-8.
13. Kim JT, Lee SH, Chun YS, Kim JC. Tear cytokines and
chemokines in patients with Demodex blepharitis.
Cytokine 2011; 53: 94-9.
14. Koo H, Kim TH, Kim KW, Wee SW, Chun YS, Kim JC.
Ocular surface discomfort and Demodex: effect of tea tree
oil eyelid scrub in Demodex blepharitis. J Korean Med Sci
2012; 27: 1574-9.
15. Holzchuh FG, Hida RY, Moscovici BK, Villa Albers MB,
Santo RM, Kara-Jose N, et al. Clinical treatment of ocular
Demodex folliculorum by systemic ivermectin. Am J
Ophthalmol 2011; 151: 1030-4 e1.
16. Connor C, Choat C, Narayanan S, Kyser K, Rosenberg B,
Mulder D. Clinical Effectiveness of Lid Debridement with
BlephEx Treatment. Invest Ophthalmol Vis Sci 2015; 56:
4440.
17. Gao YY, Di Pascuale MA, Li W, Liu DT, Baradaran-Rafii A,
Elizondo A, et al. High prevalence of Demodex in eyelas-
hes with cylindrical dandruff. Invest Ophthalmol Vis Sci
2005; 46: 3089-94.
18. Coston TO. Demodex folliculorum blepharitis. Trans Am
Ophthalmol Soc 1967; 65: 361-92.
S J Ú K R A T I L F E L L I
ENGLISH SUMMARY
Meibomian gland dysfunction (MGD) is a common cause of dry eye
disease. Demodex mites can cause MGD with symptoms like itching,
dryness and general ocular discomfort. It is important to consider
infestation with Demodex mites in individuals who are non responsive to
traditional MGD treatment but also equally important when cylindrical
dandruff is seen at the base of the eye lashes.. We report two individu-
als who had not responded to ocular and systemic treatment for MGD
and were then diagnosed with Demodex mites. Treatment with BlephEx
and Tea tree oil was successful. This is the first report on Demodex foll-
iculorum in Iceland where a genetic analysis was done.
Key words: Demodex, blepharitis, debris, tea tree oil, dry eye.
Demodex folliculorum a hidden cause of blepharitis
Sigurlaug Gunnarsdóttir1, Árni Kristmundsson2, Mark A. Freeman2,3, Ólafur Már Björnsson1, Gunnar Már Zoëga1,4
1Sjónlag Eye Center and Táralind, 2The Institute for Experimental Pathology University of Iceland, 3Ross University School of Veterinary Medicine, Basseterre, St. Kitts, West Indies.,
4Department of Ophthalmology, Landspitali University Hospital.
Key words: Demodex, blepharitis, debris, tea tree oil, dry eye.
Correspondence: Sigurlaug Guðrún Gunnarsdóttir sigurlaug@sjonlag.is