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Optometric Management

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Optometric Management November 1, 2013

Profession PULSE

OUR EXPERTS DISCUSS THE HOT TOPICS IN OPTOMETRY

DEMODEX TREATMENT

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Milton Hom, O.D., F.A.A.O.:

Ben, I heard you plan to get a BlephEx from Rysurg (www.rysurg.com).

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Ben Gaddie, O.D., F.A.A.O.: Yes, I am looking to bring in one of these devices and hope it will serve several purposes. For MGD patients, I think it is an opportunity to clean the gland orifices and remove the “crud” milieu from the lid and lash lines.

I also have great anticipation for its work with Demodex infestation, especially as this craze hits optometry. The cylindrical dandruff (CD) is near-pathognomic for Demodex and results from the decaying bodies of spent mites. Therefore, removing the dandruff is a priority if you ever hope to get the tea tree oil (TTO) into the lash follicles where it has the toxic effect on the mites.

Currently, I apply a very small amount of a mixture of TTO and macadamia nut oil to the lash line to “loosen up” the CD (the macadamia nut oil is great for greasing it). Then, I use a cotton swab to scrub the CD. This takes too long and increases the risk of getting the oil mixture onto the ocular surface, which can result in discomfort and blurry vision for the patient — at least more than is necessary.

I am hopeful that, with or without the macadamia oil, BlephEx will help lift all the mite crud from the lid and allow for full penetration of the Demodex-toxic TTO.

M.H.: I have mixed feelings about lid therapy. Past literature has shown that mite counts increase with patients using lid hygiene. However, after polling my colleagues, I found out that I have used lid hygiene during in-office treatments more than most. Go figure.

To take Coston's theory on the morphology of Demodex folliculorum further, clearing the follicle opening actually allows the mites to migrate more freely — opening the door allows males to find female mates.1 On the flip side, is it good to have all the waste products on the lids? I think not, as inflammatory markers increase when an infestation is present. OM

BlephEx Insight

We received some tips from Demodex gurus Scott Schachter, O.D., Pismo Beach, Calif., and Katherine Mastrota, O.D., M.S., F.A.A.O., Brooklyn, N.Y, about BlephEx:

S.S.: 1. Saturate the sponge and wet the lids. Surfaces dry pretty quickly, so I recommend pouring a liposome eyelid spray in a small cup.

2. Don't push the sponge in the chuck too hard. It can be difficult to remove.

3. Tetracaine works better than proparacaine to minimize the “tickling” sensation.

4. Using loupe for magnification is helpful.

5. There will be a learning curve.

6. In my experience, most cylindrical dandruff was removed, but not all.

K.M.: The sponge dries out quickly, and I had to re-wet. It should have a pause button in the next version.

I performed this at the slit lamp. Even with the BlephEx, the debris is hard to remove. I think patients should have pre-treatment with warm compresses to soften the lid debris at home or in the office.

1. Coston TO. Demodex folliculorum blepharitis. Trans Am Ophthalmol Soc. 1967;65:361-92.

DR. HOM PRACTICES IN AZUSA, CALIF. HE IS A MULTI-AWARD WINNER, MOST RECENTLY WINNING THE 2012 AOA CLCS LEGEND AWARD. E-MAIL HIM AT EYEMAGE@MMINTERNET.COM.

DR. GADDIE IS THE OWNER AND DIRECTOR OF THE GADDIE EYE CENTERS, A MULTI-LOCATION, FULL-SERVICE PRACTICE IN LOUISVILLE, KY., AND IS CURRENTLY THE CHAIR OF THE CONTINUING EDUCATION COMMITTEE FOR THE AMERICAN OPTOMETRIC ASSOCIATION. E-MAIL HIM AT IBGADDIE@ME.COM, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.

The authors report no financial interest in the product mentioned.

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