J Korean Med Sci.  2012 Dec;27(12):1574-1579. 10.3346/jkms.2012.27.12.1574.

Ocular Surface Discomfort and Demodex: Effect of Tea Tree Oil Eyelid Scrub in Demodex Blepharitis

• Koo H
• Kim TH
• Kim KW
• Wee SW
• Chun YS
• Kim JC

• KMID: 2157985
• DOI: http://doi.org/10.3346/jkms.2012.27.12.1574

Abstract

The purpose of this study was to evaluate the relation between ocular discomfort and ocular Demodex infestation, and therapeutic effects of tea tree oil (TTO) in Demodex blepharitis patients. Three hundred and thirty-five patients with ocular discomfort were evaluated for ocular Demodex infestation and subjective symptoms with ocular surface discomfort index (OSDI) score. Among them, Demodex-infested patients were randomized to receive either eyelid scrubbing with TTO (TTO group,106 patients) or without TTO (Control group, 54 patients) for 1 month. Demodex were found in 84% of patients with ocular discomfort. The number of Demodex was significantly correlated with age (P = 0.04) and OSDI score (P = 0.024). After eyelid scrub treatment, Demodex count was reduced from 4.0 +/- 2.5 to 3.2 +/- 2.3 in the TTO group (P = 0.004) and from 4.3 +/- 2.7 to 4.2 +/- 2.5 in the control group (P = 0.27). Also, OSDI score was reduced from 34.5 +/- 10.7 to 24.1 +/- 11.9 in the TTO group (P = 0.001) and from 35.3 +/- 11.6 to 27.5 +/- 12.8 in the control group (P = 0.04). In conclusion, Demodex number showed a significant positive correlation with age and subjective ocular discomfort. The tea tree oil eyelid scrub treatment is effective for eliminating ocular Demodex and improving subjective ocular symptoms.

Keyword

Blepharitis; Demodex; Ocular Surface; Tea Tree Oil

MeSH Terms

Adult
Age Factors
Aged
Aged, 80 and over
Animals
Anti-Infective Agents, Local/pharmacology/therapeutic use
Blepharitis/*drug therapy/pathology
Eye Infections, Parasitic/*drug therapy/parasitology/pathology
Eyelids/parasitology/pathology
Female
Humans
Male
Middle Aged
Mite Infestations/*drug therapy/parasitology/pathology
Mites/drug effects
Phytotherapy
Tea Tree Oil/pharmacology/*therapeutic use
Young Adult
Anti-Infective Agents, Local
Tea Tree Oil

Figure

• 

  Fig. 1 Flow chart shows the total numbers of eyes enrolled, treated, and observed during the follow-up of the study.

• 

  Fig. 2 Correlation of Demodex with age and ocular surface discomfort index. The number of Demodex showed significant positive correlations with increasing age (A; P = 0.04, correlation coefficient R = 0.563) and ocular surface discomfort index (OSDI) score (B; P = 0.024, correlation coefficient R = 0.512) in ocular discomfort patients.

• 

  Fig. 3 Changes in Demodex count (A) and OSDI score (B) after eyelid scrub in TTO group and control group. Group comparisons were performed using ANOVA and Scheffe's post hoc tests. Only significant P values are shown.

Reference

1. Basta-Juzbasić A, Subić JS, Ljubojević S. Demodex folliculorum in development of dermatitis rosaceiformis steroidica and rosacea-related diseases. Clin Dermatol. 2002. 20:135–140.

2. English FP, Nutting WB. Demodicosis of ophthalmic concern. Am J Ophthalmol. 1981. 91:362–372.

3. Kamoun B, Fourati M, Feki J, Mlik M, Karray F, Trigui A, Ellouze S, Hammami B, Chaabouni M, Ayadi A. Blepharitis due to Demodex: myth or reality? J Fr Ophtalmol. 1999. 22:525–527.

4. Humiczewska M. Demodex folliculorum and Demodex brevis (Acarida) as the factors of chronic marginal blepharitis. Wiad Parazytol. 1991. 37:127–130.

5. Coston TO. Demodex folliculorum blepharitis. Trans Am Ophthalmol Soc. 1967. 65:361–392.

6. Heacock CE. Clinical manifestations of demodicosis. J Am Optom Assoc. 1986. 57:914–919.

7. Morfin Maciel BM. Demodicidosis in a female patient treated as allergic blepharoconjunctivitis: a case report. Rev Alerg Mex. 2003. 50:232–236.

8. Gao YY, Di Pascuale MA, Li W, Liu DT, Baradaran-Rafii A, Elizondo A, Kawakita T, Raju VK, Tseng SC. High prevalence of ocular Demodex in lashes with cylindrical dandruffs. Invest Ophthalmol Vis Sci. 2005. 46:3089–3094.

9. Lee SH, Chun YS, Kim JH, Kim ES, Kim JC. The relationship between Demodex and ocular discomfort. Invest Ophthalmol Vis Sci. 2010. 51:2906–2911.

10. Kim JH, Chun YS, Kim JC. Clinical and immunological responses in ocular demodecosis. J Korean Med Sci. 2011. 26:1231–1237.

11. Kim JT, Lee SH, Chun YS, Kim JC. Tear cytokines and chemokines in patients with Demodex blepharitis. Cytokine. 2011. 53:94–99.

12. Gao YY, Di Pascuale MA, Li W, Baradaran-Rafii A, Elizondo A, Kuo CL, Raju VK, Tseng SC. In vitro and in vivo killing of ocular Demodex by tea tree oil. Br J Ophthalmol. 2005. 89:1468–1473.

13. Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000. 118:615–621.

14. Türk M, Oztürk I, Sener AG, Küçükbay S, Afşar I, Maden A. Comparison of incidence of Demodex folliculorum on the eyelash follicule in normal people and blepharitis patients. Turkiye Parazitol Derg. 2007. 31:296–297.

15. Forton F, Germaux MA, Brasseur T, De Liever A, Laporte M, Mathys C, Sass U, Stene JJ, Thibaut S, Tytgat M, Seys B. Demodicosis and rosacea: epidemiology and significance in daily dermatologic practice. J Am Acad Dermatol. 2005. 52:74–87.

16. Kemal M, Sümer Z, Toker MI, Erdoğan H, Topalkara A, Akbulut M. The prevalence of Demodex folliculorum in blepharitis patients and the normal population. Ophthalmic Epidemiol. 2005. 12:287–290.

17. Messager S, Hammer KA, Carson CF, Riley TV. Assessment of the antibacterial activity of tea tree oil using the European EN 1276 and EN 12054 standard suspension tests. J Hosp Infect. 2005. 59:113–125.

18. Halcón L, Milkus K. Staphylococcus aureus and wounds: a review of tea tree oil as a promising antimicrobial. Am J Infect Control. 2004. 32:402–408.

19. Oliva B, Piccirilli E, Ceddia T, Pontieri E, Aureli P, Ferrini AM. Antimycotic activity of Melaleuca alternifolia essential oil and its major components. Lett Appl Microbiol. 2003. 37:185–187.

20. Hammer KA, Carson CF, Riley TV. Antifungal effects of Melaleuca alternifolia (tea tree) oil and its components on Candida albicans, Candida glabrata and Saccharomyces cerevisiae. J Antimicrob Chemother. 2004. 53:1081–1085.