Correlation between ocular Demodex infestation and serum immunoreactivity to Bacillus proteins in patients with Facial rosacea

Abstract

Purpose: To investigate correlation between ocular Demodex infestation and serum.

Design: A prospective study to correlate clinical findings with laboratory data.

Participants: We consecutively enrolled 59 patients: 34 men and 25 women with a mean age of 60.4+/-17.6 years (range, 17-93).

Methods: Demodex counting was performed based on lash sampling. Serum immunoreactivity to two 62-kDa and 83-kDa proteins derived from B oleronius was determined by Western blot analysis. Facial rosacea, lid margin, and ocular surface inflammation were documented by photography and graded in a masked fashion.

Main outcome measures: Statistical significance based on correlative analyses of clinical and laboratory data.

Results: These 59 patients were age matched, but not gender matched, regarding serum immunoreactivity, ocular Demodex infestation, or facial rosacea. There was a significant correlation between serum immunoreactivity and facial rosacea (P = 0.009), lid margin inflammation (P = 0.040), and ocular Demodex infestation (P = 0.048), but not inferior bulbar conjunctival inflammation (P = 0.573). The Demodex count was significantly higher in patients with positive facial rosacea (6.6+/-9.0 vs. 1.9+/-2.2; P = 0.014). There was a significant correlation of facial rosacea with lid margin inflammation (P = 0.016), but not with inferior bulbar conjunctival inflammation (P = 0.728). Ocular Demodex infestation was less prevalent in patients with aqueous tear-deficiency dry eye than those without (7/38 vs. 12/21; P = 0.002).

Conclusions: The strong correlation provides a better understanding of comorbidity between Demodex mites and their symbiotic B oleronius in facial rosacea and blepharitis. Treatments directed to both warrant future investigation.

Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Standard face photographs of rosacea (A, C) and normal subjects (B, D) of men (A, B) and women (C, D).

Figure 2

Standard external photographs of eyelids (left column) and inferior bulbar conjunctiva (right column). Inflammation of the lid margin and the inferior bulbar conjunctiva is graded as 0 for no (A) to trace (D), as 1 for mild (B, E), and 2 for severe (C, F).

Figure 3

Western blot analyses. Representative examples of (A) positive serum immunoreactivity to both 83-kDa and 62-kDa protein bands (marked by arrows; from group I case no. 8). B, Positive to the 83-kDa protein band (from group I, case no. 20). C, Positive to the 62-kDa protein band (from group I case no. 10). D, Negative to both protein bands (from group II, case no. 35). The left lane shows the molecular weight standard.

Figure 4

Representative case (group I, no. 1). A 24 year-old man presented with mild facial rosacea (A), grade 1 lid margin inflammation with meibomian gland dysfunction (B), and superior corneal neovascularization, haze, and perilimbal injection (C). Three months after lid scrub with tea tree oil, there was notable reduction of lid margin inflammation (D), perilimbal injection, and corneal haze (E).