Change Language Deutsch
Findings
- Chronic blepharitis without improvement on standard treatment, collarettes (cylindrical dandruff at the root of eyelashes)
Management
- Eyelid hygiene with NaviBlef or TEBO Lip 1-2x/d for 2 weeks or longer if chronic, alternatively Blephademodex pads 1-2x/d for 4 weeks
- alternatively Tea tree oil 5% (CAVE: severe burning, educate patients about this side effect!) or Metronidazole gel 0.75% or Metrogel 2% 2-3x/d
- Systemic therapy in case of pronounced findings:
- Flagyl (Metronidazol) as short-term therapy: 1x 2g p.o. (=4 tbl. / 500mg) in the evening
- alternatively Metronidazole 2x500mg/d for 10 days
- CAVE: No alcohol ingestion, Antabuse side effect!
- Alternative: Azithromycin 2x250mg/d for 3 days, then 7 days break, repeat therapy cycle 4 times
- Alternative: Stromectol (Ivermectin) 2x6mg (= 2 tbl. / 3mg) on the 1st + 14th day of treatment
- not available in Switzerland, must be imported from France
- Contraindication: Pregnancy + lactation (teratogenic), children <5y or <15kg, therapy with inhibitors of P-glycoprotein
Work-up
- Slit lamp: collarettes visible? Highly correlated with Demodex blepharitis!
- have patients close their eyes, examine the lash follicles on the upper lid
- epilation of eyelashes not mandatory
- Detection of Demodex under the microscope
- epilate 2-4 eyelashes, placing them on a glass slide, put 1 drop of 0.9% NaCl and add fluorescein on top
- cover with a cover slip, place under a microscope with a burning light for approx. 10-20min (heat activates Demodex, causing them to move)
- examine them under the microscope (20-40x magnification) for the presence of mites in the area of collarettes
Sources
- EyeWiki Demodex
- crstoday.com – Collarettes Equal Demodex Blepharitis
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
- Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)