The Dry Eye Zone

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Abstract: Systemic ivermectin for ocular demodex

Clinical Treatment of Ocular Demodex folliculorum by Systemic Ivermectin.

PURPOSE: To report clinical outcomes of the treatment of ocular Demodex folliculorum with oral ivermectin.

DESIGN: Noncomparative, interventional case series.

METHODS: Setting. Institutional. Study Population. Twenty-four eyes of 12 patients (3 male and 9 female; mean age ± standard deviation, 50.4 ± 21.0 years) with refractory posterior blepharitis with the presence of D. folliculorum in lash samples were enrolled in this study. Intervention. Patients were instructed to take 1 dose of oral ivermectin (200 μg/kg). All patients were instructed to repeat the treatment after 7 days. Main outcome measures. Tear meniscus height, Schirmer I test results, noninvasive tear film break-up time (BUT), quantification of the absolute number of D. folliculorum found in the lashes, and corneal fluorescein and rose bengal staining scores were obtained from all patients 1 day before and 28 days after treatment.

RESULTS: Statistical improvement was observed in the absolute number of D. folliculorum found in the lashes after the treatment with oral ivermectin. Average values of Schirmer I test results and tear film break-up time improved statistically after the treatment of oral ivermectin. No statistical improvement was observed in average lacrimal meniscus height or value of corneal fluorescein and rose bengal staining after treatment with oral ivermectin.

CONCLUSIONS: Ivermectin successfully reduced the number of D. folliculorum found in the lashes of patients with refractory blepharitis. Oral ivermectin may be very useful as a complement in the treatment of D. folliculorum infestation with ocular manifestation, especially in cases of unsuccessful treatment related to patient compliance.

Am J Ophthalmol. 2011 Feb 18. [Epub ahead of print]
Holzchuh FG, Hida RY, Moscovici BK, Villa Albers MB, Santo RM, Kara-José N, Holzchuh R.
Department of Ophthalmology, Hospital das Clínicas of University of São Paulo, School of Medicine, São Paulo, Brazil; Department of Ophthalmology, Santa Casa de São Paulo, São Paulo, Brazil.