I really appreciated this Demodex update from Turkey. This is a good reminder that if you are suffering from stubborn recurring blepharitis, make sure your assessment includes being checked for heavy Demodex mite loads and if so, that your treatment addresses that specific issue.

In this study, they found that (1) Demodex were much more common in people who have blepharitis than people who don't, and (2) symptom scores - that is, itching, foreign body sensation and redness were more common in people who tested positive for Demodex.

J Med Entomol. 2018 Aug 17. doi: 10.1093/jme/tjy143. [Epub ahead of print]
Prevalence and Load of Demodex folliculorum and Demodex brevis (Acari: Demodicidae) in Patients With Chronic Blepharitis in the Province of Erzincan, Turkey.
Zeytun E, Karakurt Y.

Abstract
Chronic blepharitis is an ocular disease frequently encountered by ophthalmologists. Demodex mites can play a role in the pathogenesis of blepharitis along with bacterial agents, especially in treatment-resistant cases or recurrent cases after treatment. This study was performed to determine the prevalence and load of Demodex folliculorum (Simon) and Demodex brevis Akbulutova in chronic blepharitis patients and to assess the relationship between the prevalence and load of Demodex species and ocular symptoms. The study included 365 patients diagnosed with chronic blepharitis in clinical examination, and 175 controls without any chronic or ocular disease. In the study, two eyelashes were sampled from the lower and upper lids of the right and left eyes (a total of eight samples) of the participants. Eyelash samples were examined under a light microscope, and Demodex species were identified and counted. Demodex were detected in 79.2% (95% CI: 75-83%) of patients and 31.4% (95% CI: 24-38%) of controls in this study. D. folliculorum alone (mean: 4.96; min: 1; max: 17; P < 0.001) was detected in 72.3% of patients, in 0.7% D. brevis alone (mean: 1.00, P > 0.05), and in 27% both D. folliculorum and D. brevis (mean: 21.65; min: 2; max: 79; P < 0.001). In Demodex positive controls, only D. folliculorum (mean: 2.38; min: 1; max: 6) was detected while there was no D. brevis. Nevertheless, mean ocular symptom scores were significantly higher in Demodex positive patients than in Demodex negative patients (P < 0.001). Itching, foreign body sensation, and redness were the most common complaints in Demodex positive patients. As a result, Demodex mites were high in numbers in patients with chronic blepharitis in Erzincan. There was a positive correlation between Demodex mites and chronic blepharitis and ocular symptoms. It may be helpful to consider these findings in clinical assessment of blepharitis patients.

Rebecca

January 24, 2018

Two studies on manuka honey for blepharitis

Rebecca

January 24, 2018

1. Randomised masked trial of the clinical safety and tolerability of MGO Manuka Honey eye cream for the management of blepharitis.

BMJ Open Ophthalmol. 2017 Aug 4;

Craig JP1, Wang MTM1, Ganesalingam K1, Rupenthal ID1, Swift S2, Loh CS1, Te Weehi L1, Cheung IMY1, Watters GA1.

Abstract

OBJECTIVE:
To assess the clinical safety and tolerability of a novel MGO Manuka Honey microemulsion (MHME) eye cream for the management of blepharitis in human subjects.

METHODS AND ANALYSIS:
Twenty-five healthy subjects were enrolled in a prospective, randomised, paired-eye, investigator-masked trial. The MHME eye cream (Manuka Health New Zealand) was applied to the closed eyelids of one eye (randomised) overnight for 2 weeks. LogMAR visual acuity, eyelid irritation symptoms, ocular surface characteristics and tear film parameters were assessed at baseline, day 7 and day 14. Expression of markers of ocular surface inflammation (matrix metalloproteinase-9 and interleukin-6) and goblet cell function (MUC5AC) were quantified using impression cytology at baseline and day 14.

RESULTS:
There were no significant changes in visual acuity, eyelid irritation symptoms, ocular surface characteristics, tear film parameters and inflammatory marker expression during the 2-week treatment period in treated and control eyes (all p>0.05), and measurements did not differ significantly between eyes (all p>0.05). No major adverse events were reported. Two subjects experienced transient ocular stinging, presumably due to migration of the product into the eye, which resolved following aqueous irrigation.

CONCLUSION:
The MHME eye cream application was found to be well tolerated in healthy human subjects and was not associated with changes in visual acuity, ocular surface characteristics, tear film parameters, expression of markers of inflammation or goblet cell function. The findings support future clinical efficacy trials in patients with blepharitis.

2. Preclinical development of MGO Manuka Honey microemulsion for blepharitis management.

BMJ Open Ophthalmol. 2017 Aug 7

Craig JP1, Rupenthal ID1, Seyfoddin A1,2, Cheung IMY1, Uy B3, Wang MTM1, Watters GA1, Swift S3.

Abstract

OBJECTIVE:
To evaluate the in vitro antimicrobial effects of cyclodextrin-complexed and uncomplexed Manuka honey on bacteria commonly associated with blepharitis, and in vivo rabbit eye tolerability of a cyclodextrin-complexed methylglyoxal (MGO) Manuka Honey microemulsion (MHME).

METHODS AND ANALYSIS:
In vitro phase: Bacterial growth inhibition was assessed by area under the growth curve (AUC) for Staphylococcus aureus, and the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for S. aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa with cyclodextrin-complexed and uncomplexed Manuka honey were determined. In vivo phase: Six rabbits were administered 20 µL of MHME (at 1:10 dilution) to the right eye (treated) and 20 µL of saline to the left eye (control) daily, for 5 days. Tear evaporation, production, osmolarity, lipid layer, conjunctival hyperaemia and fluorescein staining were assessed daily, before and 15 min after instillation.

RESULTS:
In vitro phase: The relative AUC for cyclodextrin-complexed Manuka honey was lower than that of uncomplexed honey at both 250 and 550 mg/kg of MGO (both p <0 .05="" aeruginosa.="" all="" and="" assessed="" aureus="" both="" but="" changes="" control="" cyclodextrin-complexed="" either="" epidermidis="" eyes="" for="" had="" honey="" in="" lower="" mbc="" mic="" no="" not="" observed="" or="" p.="" p="" parameters="" phase:="" s.="" significant="" than="" the="" treated="" uncomplexed="" vivo="" were="">0.05).

CONCLUSION:
Overall, antimicrobial potency of cyclodextrin-complexed Manuka honey was greater than uncomplexed honey. No significant immediate or cumulative adverse effects were observed with MHME application on rabbit eyes, supporting future conduct of clinical safety and tolerability trials in human subjects.