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Demodexfolliculorum and D brevis are common ectopic parasites that inhabit the pilosebaceous units of the human skin. They are associated with dermatological problems such as acne, rosacea and folliculitis. 1 In ophthalmology, they are considered an aetiological factor of chronic blepharitis, meibomian gland dysfunction and ocular surface inflammation. Pathogenesis is controversial as Demodex can also be found in many asymptomatic patients. In this study, we aimed to investigate the efficacy and safety of the oral use of ivermectin in the treatment of chronic, recalcitrant blepharitis.
Patients diagnosed as having chronic symptomatic blepharitis resistant to conventional treatment were included ( figure 1A ). The participants provided written informed consent, and the study was approved by the institutional review board/ethics committee and followed the tenets of the Declaration of Helsinki. All patients underwent a thorough ophthalmic examination, including tear break-up time (BUT), symptoms' questionnaire and ocular surface disease index (OSDI), and were tested for the presence of Demodex in their eyelashes (three per eyelid) ( figure 1B ). In addition, liver function tests were performed. 2
The patients who tested positive for the presence of Demodex underwent antiparasitic oral treatment with ivermectin 6 mg twice daily for 1 day, which was repeated after 14 days. The ophthalmic and microbiological examination was repeated 30, 60 and 90 days after the last ivermectin dose.
Thirty-eight eyes from 19 patients were included in...