BLEPHARITIS - DEMODEX FOLLICULORUM, ASSOC IATED GERM SPECTRUM AND SPECIFIC THERAPY

Demodex folliculorum has been demonstrated with an elevated frequency in patients with blepharitis, and is thought to cause therapy-resistan t blepharitis. This paper presents the germ spectrum of patients with blepharitis and demodex and discusses the efficiency of a specific the rapy. Methods. In ail, 3152 cilia from 139 patients with blepharitis ( 38% blepharitis, 44% blepharoconjunctivitis, others) and 108 persons w ith quiet eyes were examined for demodex. Smears n = 125, from the con junctive of symptomatic patients were investigated for bacteria, 3 wee ks of therapy with mercury ointment, 2%: Lindan, cortisone (prednisolo ne, dexamethasone, hydrocortisone, fluorometholone) or antibiotics aft er antibiogram (gentamicin, kanamicin, neomicin, erythromicin, ofloxac in, polymyxin-B colistin) followed in all Demodex-positive blepharitis patients (n=41). Results. Demodex was found in 52% (62/139) of patien ts with chronic blepharitis, as against 20% (3/15) of those with acute blepharitis (statistically significant difference, chi(2)-test alpha= 2.5%) and in 29% of quiet eyes (statistically significantly less, alph a=2.5%, chi(2)-test). Gram-positive cocci were isolated from 79% of 57 Demodex-positive patients with blepharitis and 72% of 68 Demodex-nega tive patients anaerobes in 39% and 37%, gram-negative rods in 11% and 3% (statistically significant difference for gram-negative rods, alpha =5%, chi(2)-test). Of the patients with Demodex, 25% apparently had no more parasites after mercury ointment, 2% (n=8) and lindan (n=5) and 15% after cortisone and antibiotics (n=13). (The best and statisticall y very significant results (alpha=1%) were those obtained with mercury ointment, 2%, and lindan: t-test for connected spot checks). Conclusi ons. Gram-positive and gram-negative bacteria grew more often in patie nts with Demodex. Demodex seems to be a mediator of chronic blephariti s; we recommend that mites be sought in cilia of chronic blepharitis p atients. Mercury ointment, 2% and lindan proved efficient for specific therapy, the main problem being?he laborious application and toxicity .