[Blepharitis. Demodex folliculorum, associated pathogen spectrum and specific therapy].
Demodex folliculorum has been demonstrated with an elevated frequency in patients with blepharitis, and is thought to cause therapy-resistant blepharitis. This paper presents the germ spectrum of patients with blepharitis and demodex and discusses the efficiency of a specific therapy.


METHODS
In all, 3152 cilia from 139 patients with blepharitis (38% blepharitis, 44% blepharoconjunctivitis, others) and 108 persons with quiet eyes were examined for demodex. Smears n = 125, from the conjunctive of symptomatic patients were investigated for bacteria, 3 weeks of therapy with mercury ointment, 2%: Lindan, cortisone (prednisolone, dexamethasone, hydrocortisone, fluorometholone) or antibiotics after antibiogram (gentamicin, kanamicin, neomicin, erythromicin, ofloxacin, polymyxin-B, colistin) followed in all Demodex-positive blepharitis patients (n = 41).


RESULTS
Demodex was found in 52% (62/139) of patients with chronic blepharitis, as against 20% (3/15) of those with acute blepharitis (statistically significant difference, chi 2-test, alpha = 2.5%) and in 29% of quiet eyes (statistically significantly less, alpha = 2.5%, chi 2-test). Gram-positive cocci were isolated from 79% of 57 Demodex-positive patients with blepharitis and 72% of 68 Demodex-negative patients anaerobes in 39% and 37%, gram-negative rods in 11% and 3% (statistically significant difference for gram-negative rods, alpha = 5%, chi 2-test). Of the patients with Demodex, 25% apparently had no more parasites after mercury ointment, 2% (n = 8) and lindan (n = 5) and 15% after cortisone and antibiotics (n = 13). (The best and statistically very significant results (alpha = 1%) were those obtained with mercury ointment, 2%, and lindan: t-test for connected spot checks).


CONCLUSIONS
Gram-positive and gram-negative bacteria grew more often in patients with Demodex. Demodex seems to be a mediator of chronic blepharitis; we recommend that mites be sought in cilia of chronic blepharitis patients. Mercury ointment, 2% and lindan proved efficient for specific therapy, the main problem being the laborious application and toxicity.
Demmler
M
M
Augenklinik, Universität München.
de Kaspar
H M
HM
Möhring
C
C
Klauss
V
V
D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001762:Blepharitis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005260:Female; D001556:Hexachlorocyclohexane / Q000008:administration & dosage; D006801:Humans; D008297:Male; D017669:Mercury Compounds / Q000008:administration & dosage; D008875:Middle Aged; D008924:Mite Infestations / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011446:Prospective Studies; D013256:Steroids
D000893:Anti-Inflammatory Agents; D017669:Mercury Compounds; D013256:Steroids; D001556:Hexachlorocyclohexane