Assessment of Demodex Sp. Prevalence in Blepharitis Patients: Comparison of Light and Fluorescence Microscopy Techniques

Mustafa Kocaağa; Filiz Demirel; Evin Şingar; Ayşe Esra Karakoç

TR EN

Blefaritli Hastalarda Demodex Türlerinin Prevalansının Değerlendirilmesi: Işık ve Floresan Mikroskopi Tekniklerinin Karşılaştırılması

Öz

Amaç Demodex akarları, en yaygın görülen insan ektoparazitleri olup sıklıkla blefarit ile ilişkilidir. Yaygın görülmesine rağmen Demodex blefariti, klinik uygulamalarda yeterince tanı konulamayan ve göz ardı edilen bir durumdur. Bu çalışmada, blefarit hastalarında Demodex türlerinin yaygınlığının ve yoğunluğunun araştırılması, ışık mikroskopisi ile floresan mikroskopisinin tanısal etkinliğinin karşılaştırılması ve Demodex enfestasyonu ile klinik semptomlar arasındaki ilişkinin incelenmesi amaçlanmıştır. Yöntem Çalışmaya 120 blefaritli hasta ve 120 kontrol grubu olmak üzere toplam 240 kişi dahil edilmiştir. Her iki gruptan alınan kirpik örnekleri, Demodex akarlarını tespit etmek amacıyla ışık mikroskobu ve floresan mikroskobu kullanılarak incelenmiştir. Tüm katılımcılara uygulanan anket aracılığıyla klinik ve demografik veriler elde edilmiştir. Bulgular Demodex türleri, blefarit hastalarının %79,2'sinde (95/120) ışık mikroskopisiyle, %80,8'inde (97/120) floresan mikroskopisiyle tespit edilmiştir. Demodex türlerinin prevalansı, blefarit hastalarında kontrol grubuna kıyasla anlamlı derecede yüksek bulunmuştur (p<0.001). Floresan mikroskopisi, ışık mikroskopisine göre daha yüksek bir tespit oranı göstermiştir (p=0.012). Sonuçlar Demodex akarları, özellikle blefarit olmak üzere oküler rahatsızlıklarda önemli bir rol oynar. Demodex blefaritin fiziksel ve zihinsel sağlık üzerine olumsuz etkilerini önlemek için zamanında ve doğru teşhis ile uygun tedavi büyük önem taşımaktadır.

Anahtar Kelimeler

Assessment of Demodex Sp. Prevalence in Blepharitis Patients: Comparison of Light and Fluorescence Microscopy Techniques

Abstract

Objective Demodex mites, the most prevalent human ectoparasites, are frequently associated with blepharitis. Despite their widespread occurrence, Demodex blepharitis remains underdiagnosed and often overlooked in clinical practice. This study investigates the prevalence and density of Demodex species in blepharitis patients, compares the diagnostic effectiveness of light and fluorescence microscopy, and examines the relationship between Demodex infestation and associated clinical symptoms. Methods A total of 240 people, 120 patients with blepharitis and 120 controls, were included in the study. Eyelash samples from both groups were analyzed using light microscopy and fluorescence microscopy to detect Demodex mites. Additionally, clinical and demographic data were gathered through a structured questionnaire. Results Demodex spp. were detected in 79.2% (95/120) of blepharitis patients by light microscopy and in 80.8% (97/120) by fluorescence microscopy. The prevalence of Demodex spp. was significantly higher in patients with blepharitis compared to controls (p<0.001). Fluorescent microscopy exhibited a higher detection rate than light microscopy (p=0.012). Conclusions Demodex mites play a significant role in ocular disorders, particularly blepharitis. Timely and accurate diagnosis, along with appropriate treatment, is essential to prevent the adverse mental and physical health impacts associated with Demodex blepharitis.

Keywords

Ethical Statement

This study was approved by Ethics Committee of Health Science University, Ankara Training and Research Hospital, Noninvasive Clinic Ethics Committee (Approval date: 05.12.2019; Number: E-19/127)

References

1. Elston CA, Elston DM. Demodex mites. Clin Dermatol. 2014;32(6):739-743. DOI: 10.1016/j.clindermatol.2014.02.012.
2. Erdal B, Albayrak H. Investigation of the prevalence of Demodex spp. in dermatological diseases. Turkiye Parazitol Derg. 2022;46(1):54-59. DOI: 10.4274/tpd.galenos.2021.93685.
3. Rather PA, Hassan I. Human Demodex mite: The versatile mite of dermatological importance. Indian J Dermatol. 2014;59(1):60-66. DOI: 10.4103/0019-5154.123498.
4. Rusiecka-Ziółkowska J, Nokiel M, Fleischer M. Demodex - an old pathogen or a new one? Adv Clin Exp Med. 2014;23(2):295-298. DOI: 10.17219/acem/37081.
5. Fromstein SR, Harthan JS, Patel J, Opitz DL. Demodex blepharitis: clinical perspectives. Clin Optom (Auckl). 2018;10:57-63. DOI: 10.2147/OPTO.S142708.
6. Wesolowska M, Knysz B, Reich A, Blazejewska D, Czarnecki M, Gladysz A, Pozowski A, et al. Prevalence of Demodex spp. in eyelash follicles in different populations. Arch Med Sci. 2014;10(2):319-324. DOI: 10.5114/aoms.2014.42585.
7. Lacey N, Kavanagh K, Tseng SC. Under the lash: Demodex mites in human diseases. Biochem (Lond). 2009;31(4):2-6.
8. Liu J, Sheha H, Tseng SC. Pathogenic role of Demodex mites in blepharitis. Curr Opin Allergy Clin Immunol. 2010;10(5):505-510. DOI: 10.1097/ACI.0b013e32833df9f4

9. Luo X, Li J, Chen C, Tseng S, Liang L. Ocular demodicosis as a potential cause of ocular surface inflammation. Cornea. 2017;36 Suppl 1(Suppl 1): 9-14. DOI: 10.1097/ICO.0000000000001361.
10. Bitton E, Aumond S. Demodex and eye disease: a review. Clin Exp Optom. 2021;104(3):285-294. DOI: 10.1111/cxo.13123.
11. Chioveanu FG, Niculet E, Torlac C, Busila C, Tatu AL. Beyond the Surface: Understanding Demodex and Its Link to Blepharitis and Facial Dermatoses. Clin Ophthalmol. 2024; 24;18:1801-1810. DOI: 10.2147/OPTH.S440199.
12. Niu, Q., Cai, S., Yang, C. et al. In vitro culture and morphological observation of human eye demodex mites. Sci Rep. 2024; 14, 23357. DOI: 10.1038/s41598-024-74178-x
13. O'Dell L, Dierker DS, Devries DK, Garlich J, Whitley WO, Holdbrook M, Baba SN, et al. Psychosocial impact of Demodex blepharitis. Clin Ophthalmol. 2022;16: 2979-2987. DOI: 10.2147/OPTH.S374530.
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(4):296-297.
15. Tanrıverdi C, Demirci G, Balcı Ö, Odabaşı M, Özsütçü M. Investigation of Demodex parasitic existence in treatment-resistant chronic blepharitis cases. Turkiye Parazitol Derg 2018; 42: 130-133. DOI: 10.5152/tpd.2018.5462.
16. Demirkazık M, Koltaş İS. Blepharitis Caused by Demodex. Turkiye Parazitol Derg 2020;44(1):21-24.
17. Akkucuk S, Kaya OM, Aslan L, Ozdemir T, Uslu U. Prevalence of Demodex folliculorum and Demodex brevis in patients with blepharitis and chalazion. Int Ophthalmol. 2023;43(4):1249-1259. DOI: 10.1007/s10792-022-02523-y.
18. Li J, Luo X, Liao Y, Liang L. Age differences in ocular demodicosis: Demodex profiles and clinical manifestations. Ann Transl Med. 2021;9(9):791. DOI: 10.21037/atm-20-7715.
19. Rhee MK, Yeu E, Barnett M, Rapuano CJ, Dhaliwal DK, Nichols KK, Karpecki P, et al. Demodex Blepharitis: A comprehensive review of the disease, current management, and emerging therapies. Eye Contact Lens. 2023;49(8):311-318. DOI: 10.1097/ICL.0000000000001003.
20. Tas Cengiz Z, Ozkol HU, Beyhan YE, Ozturk M, Yilmaz H. Evaluation of some chronical diseases in etiopathogenesis of demodicosis. Dermatologica Sinica 2017; 35: 173–176. DOI: 10.1016/j.dsi.2017.04.006.
21. Toka Özer T, Akyürek Ö, Durmaz S. Association between Demodex folliculorum and metabolic syndrome. J Cosmet Dermatol. 2020;19(11):3145-3149. DOI: 10.1111/jocd.13721.
22. Enginyurt O, Karaman U, Cetin F, Ozer A. The prevalence of Demodex species and its relationship with the metabolic syndrome in women of Malatya province, Turkey. Jundishapur J Microbiol. 2015;8(10):e24322. DOI: 10.5812/jjm.24322.
23. Shah PP, Stein RL, Perry HD. Update on the Management of Demodex Blepharitis. Cornea. 2022;41(8):934-939. DOI: 10.1097/ICO.0000000000002911.
24. An N, Dou X, Yin N, Lu H, Zheng J, Liu X, Yang H, et al. The use of digital PCR for the diagnosis of Demodex blepharitis. Curr Eye Res. 2024;49(1):33-38. DOI: 10.1080/02713683.2023.2265083.
25. Wang S, Bao F. Efficient and economical observation method for Demodex mites. J Am Acad Dermatol. 2024;91(2):e25-e26. doi:10.1016/j.jaad.2024.01.071
26. Clanner-Engelshofen BM, French LE, Reinholz M. Methods for extraction and ex-vivo experimentation with the most complex human commensal, Demodex spp. Exp Appl Acarol. 2020;80(1):59-70. DOI: 10.1007/s10493-019-00450-9.

Details

Primary Language

English

Subjects

Health Management , Health Services and Systems (Other)

Journal Section

Research Article

Authors

Mustafa Kocaağa
0000-0003-4150-1947
Türkiye

Filiz Demirel ^*
0000-0002-3513-8347
Türkiye

Evin Şingar
0000-0002-8452-8595
Türkiye

Ayşe Esra Karakoç
0000-0001-6332-1109
Türkiye

Publication Date

September 30, 2025

Submission Date

December 18, 2024

Acceptance Date

September 12, 2025

Published in Issue

Year 2025 Volume: 47 Number: 3

IZ

https://izlik.org/JA24FJ87GY

Cite

RIS / Bibtex

AMA

1.Kocaağa M, Demirel F, Şingar E, Karakoç AE. Assessment of Demodex Sp. Prevalence in Blepharitis Patients: Comparison of Light and Fluorescence Microscopy Techniques. CMJ. 2025;47(3):3-9. https://izlik.org/JA24FJ87GY