Banishin Ocular Demodex

D emodex is the most common res­ ident parasite of human skin, finding a home in hair follicles and sebaceous glands. Two Demodex species, Demode.x jolliculorum and Demodex brevis, often c<"lexist in areas such as the cheeks, forehead, nose, and e.xternal car, where active sebum ex­ cretion favors their growth and breed­ ing. In the periocular area, D. jolJicu lorum lives in eyelash follicles, while D. brevis burrows deep into meibomian glands and lash sebaceous glands. In low densities, Demodex mites rarely cause problems, and whether there is ocular pathology associated with their infestation, or overgrowth, remains controversial. I In large part, this uncertainty stems from the dif­ ficulty of isolating and counting these microscopic mites on the eyelashes of symptomatic patients. Nonetheless, longstanding suspicions link ocular Demodex infestation to significant in­ flammation ofthe ocular surface and lid margins, with symptoms that illdude ocular burning, itching, and redness.H During his years as a professor at the University of Miami's Bascom Palmer Eye Institute, Scheffer Tseng, MD, investigated the ocular mani­ festations of Demodex, and together we have continued this work under the auspices of The Ocular Surface Research and Education Foundation. Our studies and clinical experience suggest that Demodex is a frequently overlooked cause of blepharitis and meibomitis, and that the ocular irrita­ tion caused by Demodex is frequentl)' misdiagnosed as dry eye disease or ocular allergy. Our research has con­ firmed a strong correlation between periocular Demodex infestation and facial rosacea and suggests that the causative link may be hypersensitivity to the Bacillus bacteria that reside on and within Demodex mites."'