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Significant correlation between meibomian gland dysfunction and keratitis in young patients with Demodex brevis infestation
  1. Lingyi Liang1,
  2. Yan Liu1,
  3. Xiaohu Ding1,
  4. Hongmin Ke1,
  5. Chuan Chen1,
  6. Scheffer C G Tseng2
  1. 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
  2. 2Ocular Surface Clinic, Ocular Surface Center, Miami, Florida, USA
  1. Correspondence to Professor Lingyi Liang, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou 510060, China; lingyiliang{at}


Aims To report the clinical characteristics and correlation between meibomian gland dysfunction (MGD) and keratitis in young patients with ocular demodicosis.

Methods Observational case series of 60 patients younger than 35 years with ocular demodicosis, of which the diagnosis was based on microscopic counting of Demodex folliculorum and D. brevis of epilated lashes. Severity of keratitis and MGD was graded by photography and meibography, respectively, in a masked fashion.

Results MGD was detected in 54/60 (90%) patients with the loss of meibomian gland in the upper lid more than the lower lid (p<0.001). Blepharoconjunctivitis and a variety of corneal pathologies were noted in 47/60 (78.3%) and 39/60 (65%) patients, respectively. For a total of 120 eyes, normal cornea was noted in 53 (44.2%) eyes, superficial punctate keratitis or limbitis was noted in 17 (14.2%), while corneal stromal infiltration was found in 50 (41.7%) eyes. Both univariate and multivariate analyses showed that the severity of meibomian gland loss was significantly correlated with higher D. brevis count and more severe keratitis (all p<0.05). Rapid resolution of keratitis and blepharoconjunctivitis was accompanied by significant reduction of the Demodex count in 48 patients receiving lid scrub directed to kill mites.

Conclusions There is a significant correlation between MGD and keratitis in young patients with ocular demodicosis especially inflicted by D. brevis.

  • ocular surface
  • inflammation

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  • Contributors LL and SCGT designed the study and reviewed the manuscript. LL, YL and HK researched and collected the data. LL, YL and XD wrote and edited the manuscript. XD analysed the data. CC contributed to discussion and reviewed the manuscript.

  • Funding This study is supported in part by a grant (81770892) from the National Natural Science Foundation of China, a grant (2014B020226003) from the Technological Project Foundation of Guangdong Province, a grant (201510010219) from the Technological Project Foundation of Guangzhou and a grant (R44 EY019586) from the National Eye Institute, the National Institutes of Health (to SCGT).

  • Disclaimer The sponsors or funding organisations had no role in the design or conduct of this research; collection, management, analysis and interpretation of the data and preparation, review or approval of the manuscript.

  • Competing interests SCGT has filed two patents for the use of tea tree oil and its ingredients for treating demodicosis. Cliradex is formulated by inclusion of the active ingredient identified through the support of grant R43 EY019586 (NEI, NIH).

  • Ethics approval This study is approved by the Ethics Committee of the Zhongshan Ophthalmic Center (Guangzhou, China).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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