title: Demodex.
abstract: OBJECTIVE
  Demodex folliculorum and Demodex brevis are ectoparasites with an astounding prevalence of 100% in patients aged 70 years and older. Every person in this age group is estimated to carry a colony of 1000 to 2000 mites. With such a high prevalence, little attention has been paid to the mite among eye care practitioners. We demonstrate a clinical sequence in a set of case reports to identify the mite. The clinical sequence includes a clinical history of blepharitis, dry eyes, and/or ocular allergy; slit lamp examination of cylindrical dandruff; and confirmation using light microscope evaluation of epilated lashes.
  
  
  METHODS
  Patient 1 was a 68-year-old woman who demonstrates associations with dry eyes and diabetes. Patient 2 was a 44-year-old man with uncommonly seen D. brevis present. Patient 3 was a 40-year-old woman with dry eyes and allergy, showing mite tails protruding from base of lashes. Patient 4 was a 60-year-old woman who demonstrates the association with rosacea. Patient 5 was a 53-year-old woman intermittently taking topical steroid and antibiotic combination medications, with an actual mite photographed on the surface.
  
  
  CONCLUSIONS
  Following a clinical sequence helps identify Demodex, the underdiagnosed, undertreated, and underappreciated ocular surface disease.
authors.affiliation: Omni Eye Surgery, New York, NY, USA. eyemage@mminternet.com
authors.forename: Milton M
authors.initials: MM
authors.lastname: Hom
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Mastrota
authors.forename: Scott E
authors.initials: SE
authors.lastname: Schachter
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001762:Blepharitis / Q000175:diagnosis* / Q000469:parasitology; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000469:parasitology; D015822:Eye Infections, Parasitic / Q000175:diagnosis* / Q000469:parasitology; D005140:Eyelashes / Q000469:parasitology*; D005260:Female; D018859:Hair Follicle / Q000469:parasitology; D006801:Humans; D008297:Male; D008537:Meibomian Glands / Q000469:parasitology / Q000473:pathology; D008875:Middle Aged; D008924:Mite Infestations / Q000175:diagnosis* / Q000469:parasitology; D008925:Mites