LAUSR

© BMJ Publishing Group Limited 2022. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION Demodex is a lid commensal that can cause ocular surface inflammation, blepharitis and blepharokeratoconjunctivitis. Demodex folliculorum and Demodex brevis are the most common species causing anterior and posterior blepharitis, respectively. We report varied clinical presentations of ocular demodicosis encountered in a rural population. In all patients, eyelash samples were examined under the microscope after preparation with glycerol/10% potassium hydroxide. On detection of Demodex mites, patients were treated with lid scrubs and application of diluted (50%) tea tree oil over the lid margins. Case 1: A woman in her 60s presented with complaints of bilateral ocular irritation and itching for 1 month. On examination, she had prominent greasy scaling at the eyelash roots. No corneal involvement was noted. Eyelash samples revealed Demodex mites (figure 1A–C). Symptoms and signs resolved after 1 month of medical management. Case 2: A teenaged boy presented with bilateral scaling and cylindrical dandruff around lashes and conjunctival congestion for 1 week. Demodex (figure 1D–H) was detected and he was started on antiDemodex management. Case 3: A woman in her 20s presented with ocular irritation and examination showed scaling of eyelashes with cylindrical dandruff, bilateral superficial punctate keratitis and inferonasal pannus over the cornea. No other abnormalities were noted. She was initially treated for seborrhoeic blepharitis alone. Since no improvement was noted, lash samples were taken and revealed Demodex mites (figure 2A–F). Symptomatic improvement was noted within 2 weeks of starting therapy. Case 4: A man in his 20s showed a ‘V’ shaped corneal infiltrate near limbus in his left eye and bilateral scaling of eyelashes. No organisms were Figure 1 (A) Slit lamp photograph of Case 1 showing severe scaling of eyelashes (white arrows). (B) Microscopic examination of lash samples taken on a glass slide with one drop of glycerol/potassium hydrooxide and a cover slip from Case 1 (blue arrows) (4 x) showing multiple Demodex mites (black arrow heads). (C) Microscopic examination of lash samples seen under higher magnification [red circle in 1 B (10 x) (Case 1)]. (D) Slit lamp photograph of the right eye and left eye (E) showing cylindrical dandruff around the lashes (white arrow) (Case 2). (F, G) Larval stage of Demodex mite (40 x) (Case 2). (H) Adult stage, Demodex folliculorum (40 x) (Case 2).