蠕形螨睑缘炎的危险因素及发病机制研究进展

蠕形螨是人体内一种常见的小型寄生虫, 体长约150～350 μm, 主要分布在人类的皮脂腺和皮肤毛囊中。近年来众多的皮肤科及眼科方面的研究表明蠕形螨与玫瑰痤疮、睑缘炎等多种疾病的发生和发展有关, 其中蠕形螨睑缘炎已成为临床的关注点之一。蠕形螨睑缘炎是蠕形螨感染睑缘而引起的睑缘皮肤炎症反应, 严重者甚至会累及角膜和结膜, 影响视力。蠕形螨睑缘炎是一种广泛存在且容易忽视的疾病, 睑缘炎患者蠕形螨的感染率可达90%, 病原学诊断方法主要有光学显微镜检查及活体共聚焦显微镜检查。目前蠕形螨睑缘炎的治疗主要以除螨治疗为主, 常用药物有茶树油、甲硝唑等。其高危因素及发病机制尚不完全明确。本文主要针对国内外有关蠕形螨睑缘炎的危险因素及其可能的发病机制进行总结和分析, 以期为进一步开展相关研究及临床治疗提供参考。     

睑缘炎患者眼部蠕形螨感染调查分析

目的 了解睑缘炎患者人体蠕形螨的感染情况及眼部蠕形螨感染存在的可能相关因素.方法 收集眼科门诊睑缘炎患者及其他伴眼痒症状外眼眼疾患者,拔取受检者眼部睫毛,进行蠕形螨检查.结果共收集满足条件患者71例,其中40例为睑缘炎患者,31例为非睑缘炎患者.40例睑缘炎患者中36例(90%)蠕形螨感染阳性,31例非睑缘炎患者中,10例(32.3%)蠕形螨感染阳性.两组间蠕形螨感染率存在显著性差异.且在36例蠕形螨感染的睑缘炎患者中,年龄在40岁以上的患者为72.2%(26例),55.6%(20例)患者病程大于等于6个月.结论 睑缘炎患者蠕形螨感染率明显较高,蠕形螨感染可能是顽固性睑缘炎致病原因之一.     

蠕形螨睑缘炎的危险因素及发病机制研究进展北大核心CSCD

蠕形螨是人体内一种常见的小型寄生虫,体长约150~350μm,主要分布在人类的皮脂腺和皮肤毛囊中。近年来众多的皮肤科及眼科方面的研究表明蠕形螨与玫瑰痤疮、睑缘炎等多种疾病的发生和发展有关,其中蠕形螨睑缘炎已成为临床的关注点之一。蠕形螨睑缘炎是蠕形螨感染睑缘而引起的睑缘皮肤炎症反应,严重者甚至会累及角膜和结膜,影响视力。蠕形螨睑缘炎是一种广泛存在且容易忽视的疾病,睑缘炎患者蠕形螨的感染率可达90%,病原学诊断方法主要有光学显微镜检查及活体共聚焦显微镜检查。目前蠕形螨睑缘炎的治疗主要以除螨治疗为主,常用药物有茶树油、甲硝唑等。其高危因素及发病机制尚不完全明确。本文主要针对国内外有关蠕形螨睑缘炎的危险因素及其可能的发病机制进行总结和分析,以期为进一步开展相关研究及临床治疗提供参考。     

睑缘鳞屑与眼睑蠕形螨寄居关系的临床分析

蠕形螨广泛存在于自然界,迄今只有两个种类被发现寄居于人体体表,即毛囊蠕形螨和皮脂蠕形螨.蠕形螨寄居眼部后临床表现轻重不一,从无任何不适到睑缘充血,痒,刺痛感,异物感等睑缘炎典型体征.蠕形螨导致的睑缘炎常反复发作,难彻底治愈,在睑缘常发现鳞屑存在[1-2].为了研究眼部蠕形螨感染的规律,本文对睑缘鳞屑数量的多少和睫毛蠕形螨计数进行研究,探讨睑缘鳞屑数量与睫毛蠕形螨寄居关系.     

睑缘鳞屑与眼睑蠕形螨寄居关系的临床分析

蠕形螨广泛存在于自然界,迄今只有两个种类被发现寄居于人体体表,即毛囊蠕形螨和皮脂蠕形螨.蠕形螨寄居眼部后临床表现轻重不一,从无任何不适到睑缘充血,痒,刺痛感,异物感等睑缘炎典型体征.蠕形螨导致的睑缘炎常反复发作,难彻底治愈,在睑缘常发现鳞屑存在[1-2].为了研究眼部蠕形螨感染的规律,本文对睑缘鳞屑数量的多少和睫毛蠕形螨计数进行研究,探讨睑缘鳞屑数量与睫毛蠕形螨寄居关系.     

5％茶树油眼膏治疗蠕形螨相关鳞屑性睑缘炎

目的探讨5％茶树油眼膏治疗蠕形螨相关鳞屑性睑缘炎的临床疗效。方法前瞻性临床研究。选择2007年6月至2013年6月在福建医科大学附属第二医院就诊的240例鳞屑性睑缘炎患者,平均年龄（48.7±13.7）岁。所有患者睫毛蠕形螨镜检均为阳性,有不同程度的眼部不适（以眼表症状积分表示）。治疗方法：使用5％茶树油眼膏擦拭双眼睑缘,每晚1次,每 2周随访1次,治疗4周后进行疗效评价,随访3个月。评价指标包括眼表不适症状改善情况、蠕形螨计数、睑缘清洁度以及不良事件发生情况。治疗前后各数据比较采用配对t检验。结果240例患者中180例（75.0%）不适症状消失,38例（15.8%）明显缓解,治疗前眼表症状积分为（8.2±3.2）分,治疗4周后降至（0.3±0.8）分（t=12.28,P<0.01）;212例（88.3%）患者睑缘变清洁;治疗前蠕形螨镜检计数为（6.2±4.8）只/4根睫毛,治疗后降至（0.7±0.6）只/4根睫毛（t=6.96,P<0.01）。所有患者均未出现过敏或不良反应。结论5%茶树油眼膏擦拭睑缘能有效缓解蠕形螨相关鳞屑性睑缘炎的临床症状,降低眼部蠕形螨寄生数量,是治疗蠕形螨相关鳞屑性睑缘炎的安全有效方法。     

睫毛毛囊蠕形螨感染与睑板腺功能障碍的关系

目的 分析睫毛毛囊蠕形螨感染与睑板腺功能障碍（meibomian gland dysfunction,MGD）发生的相关性。设计 前瞻性病例系列。研究对象 2015年9月至2016年3月北京同仁医院眼科门诊MGD患者60例（60眼）,平均年龄（43.10±12.64）岁。方法 根据睑缘充血有无分为有炎症的MGD组（A组,38例）、无炎症的MGD组（B组,22例）,再将A组中蠕形螨检出阳性者,根据蠕形螨数量的不同分为3~6只/眼组（a组）、7~10只/眼组（b组）、＞10只/眼组（c组）。对患者的一般情况、睫毛毛囊蠕形螨检出率及各体征评分进行统计分析。主要指标 睫毛毛囊蠕形螨检出率、睑缘体征、睑板腺分泌物性状、分泌难易程度及睑板腺缺失评分。 结果 A组患者蠕形螨检出阳性率为86.84%,高于B组患者（18.18%）（P=0.001）。A组患者睑缘鳞屑、睑板腺分泌物性状、分泌难易程度评分分别为1.76±1.12、1.79±0.47,1.70±0.98,均高于B组（分别为0.52±0.51、1.34±0.53、0.68±0.60）（P=0.001、0.004、0.001）;两组睑板腺缺失比较,无统计学差异（P=0.091）。a、b、c三组间睑缘鳞屑和睑板腺分泌难易程度评分均存在明显统计学差异。在A组蠕形螨检出阳性的33例患者中,蠕形螨检出数量与睑缘鳞屑（r=0.65,P=0.001）及睑板腺分泌物排出难易程度（r=0.64,P=0.001）呈高度正相关,而与睑缘充血、睑板腺分泌物性状及睑板腺缺失无相关性（P=0.197、0.114、0.988）。结论 睫毛毛囊蠕形螨感染可通过导致睑缘炎性反应,引起或加重睑板腺功能障碍。对睑板腺功能障碍伴有睑缘炎的患者应注意排除睫毛毛囊蠕形螨感染的可能。（眼科, 2016, 25： 387-390）     

中老年睫毛蠕形螨感染与睑板腺功能障碍的相关性分析

目的：调查中老年睑板腺功能障碍(MGD)患者睫毛蠕形螨的感染情况,以分析睫毛蠕形螨感染与MGD的相关性。

方法：将2017-09/2018-03于福建省老年医院眼科门诊就诊的中老年患者(年龄≥40岁),分为MGD组患者137例137眼和非MGD组患者96例96眼,进行裂隙灯下检查睑缘情况、睑板腺脂质分泌性状、角膜荧光染色及泪膜破裂时间等相关检查。同时取受检者眼部睫毛,在显微镜下查找蠕形螨并计算其数量。比较两组患者蠕形螨检出阳性率,并分析蠕形螨感染数量与睑缘评分、睑板腺脂质分泌性状评分、角膜荧光染色评分、泪膜破裂时间的相关性。

结果：MGD组患者蠕形螨检出阳性率为89.1%,高于非MGD组患者(74.0%,P<0.05)。蠕形螨感染数量与睑缘评分(r=0.89,P<0.05)、睑板腺脂质分泌性状评分(r=0.67,P<0.05)、角膜荧光染色评分(r=0.35,P<0.05)均呈正相关,与泪膜破裂时间呈负相关(r=-0.37,P<0.05)。非MGD组蠕形螨感染阳性患者中轻度感染率为60.6%,显著高于MGD组(37.7%,P<0.05)。

结论：中度及重度以上的眼部蠕形螨感染和MGD的发生密切相关,可能是中老年MGD患者的致病因素。     

Efficacy and safety evaluation of three medicated eye patches in Demodex blepharitis: a multicenter,double-blind,randomized controlled clinical trial北大核心CSCD

目的评价并比较不同含药眼贴治疗蠕形螨睑缘炎临床疗效及安全性。方法采用多中心双盲随机平行对照临床试验方法,于2021年7月至2022年12月分别在上海静安区市北医院眼科、西安市第四医院眼科、昆明第一人民医院眼科招募蠕形螨睑缘炎患者140例280眼,用随机数字表将患眼随机分为茶树精油组、秋葵精油组、基液对照组和甲硝唑组,采用双盲法分别用含20%茶树精油、1%秋葵精油、制备基液、2%甲硝唑的眼贴贴敷眼部28 d,评估治疗前及治疗第14天和第28天患者睑缘蠕形螨计数;采用眼表疾病指数量表(OSDI)对眼表症状进行评分;裂隙灯显微镜下对睑缘充血程度、睫毛根部袖套样分泌物进行评分。依据上述综合评分计算治疗有效率,并观察受试者不良反应情况。结果所有受试者均完成治疗和随访,失访率为0%。各组治疗14和28 d受试眼睑缘蠕形螨计数较治疗前均明显减少(均P<0.05)。治疗28 d,茶树精油组、秋葵精油组和甲硝唑组蠕形螨数量明显低于基液对照组,差异均有统计学意义(均P<0.05)。茶树精油组、秋葵精油组和甲硝唑组治疗14和28 d时受试眼OSDI评分、睑缘充血评分和袖套样分泌物评分均明显低于治疗前,差异有统计学意义(均P<0.05)。治疗28 d,茶树精油组、秋葵精油组和甲硝唑组治疗有效率分别为71.4%、71.4%和62.9%,明显高于基液对照组的25.7%。治疗及随访期间未发现严重的局部及全身不良反应。结论含茶树精油、秋葵精油、甲硝唑眼贴治疗蠕形螨睑缘炎效果显著,可有效改善睑缘生物环境,消除睑缘相关炎症反应。     

眼部蠕形螨感染与蔬菜芽胞杆菌蛋白免疫反应的相关关系

目的:研究人眼蠕形螨感染与其血清免疫反应的关系.方法:观察68例住院患者眼部蠕形螨感染情况,收集每例患者双眼上下睑共8条睫毛,进行蠕形螨计数,分别记录毛囊蠕形螨和皮脂蠕形螨数量.用Western blot分析从蔬菜芽胞杆菌分离出来的两种蛋白62-kDa和83-kDa与患者血清的免疫反应情况.结果:所有68例患者无面部红斑痤疮,无眼睑炎,按血清反应分阳性和阴性两组,年龄匹配(P=0.888),性别匹配(P=0.595);按睫毛蠕形螨感染分阳性和阴性两组,年龄匹配(P=0.590),性别匹配(P=0.329).血清免疫反应与眼部蠕形螨感染无统计学相关关系(P=0.925),在蠕形螨感染阳性组38例中27例(71％)血清反应阳性,在蠕形螨感染阴性组30例中,血清反应阳性21例(70％).与蠕形螨计数也无统计学相关关系(P=0.758).结论:当眼部感染蠕形螨但不发病时,血清检查不必要,但当眼部出现眼睑炎时,建议查睫毛螨虫和血清免疫反应,一旦两者均阳性,全力除虫实属必要.     

Prevalence of ocular demodicosis among patients at Tertiary Care Center, Bangkok, Thailand

AIM: To determine the prevalence of ocular demodicosis by both microscopic examination and molecular detection among patients at King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok. METHODS: One hundred individuals were enrolled in the study and were divided into five age groups. The meibomian gland dysfunction (MGD) score and qualities of cylindrical dandruff (CD) were also determined. Demodex mite infestations of eyelash samples were screened by both microscopic examination and semi-nested polymerase chain reaction (PCR). RESULTS: The prevalence of ocular demodicosis as determined by microscopic examination was 42% [Demodex folliculorum (D. folliculorum) 41% and Demodex brevis (D. brevis) 1%]. Among patients who had ocular Demodex infestation, 69% have CD and had an average MGD score of 4; in patients without demodicosis, 15.5% had CD and had an average MGD score of 4.12. Prevalence of ocular demodicosis as determined by semi-nested PCR was 79% (D. folliculorum 78% and D. brevis 1%). CONCLUSION: This is the first report on the prevalence of ocular demodicosis in Thailand. Patients with CD also had Demodex mites present. Semi-nested PCR is better than microscopy for Demodex infestation detection. An extensive survey with more representative samples is required to determine the prevalence in the country.     

不同浓度茶树精油治疗蠕形螨睑缘炎的有效性及安全性

目的:分析不同浓度茶树精油治疗蠕形螨睑缘炎的有效性及安全性。方法:回顾性分析2017-06/2019-06于本院就诊的蠕形螨感染所致睑缘炎患者120例240眼临床资料,按照使用茶树精油浓度10%、15%、20%、25%将患者分4组,每组各30例60眼。给予所有患者睑板腺按摩、睑缘清洁,再用不同浓度的茶树精油擦洗清洁睑缘。比较各组治疗前、治疗2、4wk后蠕形螨数量、临床症状评分、临床体征评分、泪膜破裂时间(BUT)、角膜荧光素染色(FL)和泪液分泌试验(SⅠt)差异。结果:四组患者治疗前蠕形螨数量、临床症状评分、临床体征评分、BUT、FL和SⅠt比较均无差异(P>0.05)。治疗后,各组患者蠕形螨数量、临床症状评分、临床体征评分均较治疗前降低,且各组治疗4wk后蠕形螨数量、临床症状评分、临床体征评分均低于治疗2wk后(均P<0.008)。治疗2、4wk后各组间蠕形螨数量、临床症状评分、临床体征评分以10%茶树精油组最高,25%茶树精油组最低(均P<0.008)。治疗后各组BUT较治疗前升高,并于第4wk达到峰值。治疗2、4wk后各组间BUT以25%茶树精油组最高、10%茶树精油组最低(均P<0.008)。治疗后各组FL、SⅠt较治疗前降低,并于第4wk达到最低值。治疗2、4wk后各组间FL均以25%茶树精油组最低、10%茶树精油组最高(均P<0.008)。结论:与10%茶树精油组相比,15%茶树精油组可有效驱螨、缓解蠕形螨睑缘炎患者临床症状和眼部体征,且安全性高于20%、25%茶树精油组,可作为抗蠕形螨睑缘炎茶树精油的首选浓度。     

High prevalence of Demodex in eyelashes with cylindrical dandruff

PURPOSE: To determine the prevalence of Demodex in eyelashes with cylindrical dandruff (CD). METHODS: A modified sampling and counting method was applied to 55 clinical cases. Patients were divided in to group A (n = 20) with diffuse CD, group B (n = 12) with sporadic CD, and group C (n = 23) with clean lashes or greasy scales, of which the latter was divided into subgroup C1 (n = 15) without lid hygiene and subgroup C2 (n = 8) using daily lid hygiene for the past year. Each patient underwent a routine complete eye examination and modified counts of Demodex. RESULTS: Demodex was found in all group A and B patients (n = 32) with CD, which was significantly higher than the 22% of group C patients (n = 23) without CD (P < 0.001). The Demodex counts were 4.1 +/- 1.0 and 2.0 +/- 1.2 per epilated lash with retained CD, significantly higher than the 0.2 +/- 0.5 and 0.2 +/- 0.4 per lash without retained CD in groups A and B, respectively (each P < 0.001) and than the 0.01 +/- 0.09 and 0.12 +/- 0.41 per lash in subgroups C1 and C2, respectively (each P < 0.001). Demodex was still found in CD fragments left on the lid skin after epilation. Five Demodex brevis mites were found among the 422 Demodex specimens. CONCLUSIONS: The modified sampling and counting method showed that the prior controversy regarding Demodex has resulted from miscounting and confirmed that lashes with CD are pathognomonic for ocular Demodex infestation. Lid hygiene with shampoo reduces Demodex counts but does not eradicate the mites.     

Corneal manifestations of ocular demodex infestation

PURPOSE: To report the corneal manifestations in eyes with Demodex infestation of the eyelids. DESIGN: Noncomparative, interventional case series. METHODS: This retrospective review included six patients with Demodex blepharitis who also exhibited corneal abnormalities, which led to suspicion of limbal stem cell deficiency in three cases. All patients received weekly lid scrubs with 50% tea tree oil and a daily lid scrubs with tea tree shampoo for a minimum of six weeks. Improvement of symptoms and corneal and conjunctival signs were evaluated. RESULTS: All six patients exhibited ocular irritation and conjunctival inflammation, while meibomian gland dysfunction (n = 5), rosacea (n = 4), and decreased vision (n = 3) also were noted despite prior treatments with oral tetracycline, topical steroids with antibiotics, and lid scrub with baby shampoo. These patients were proven to have Demodex folliculorum (n = 6) and Demodex brevis (n = 3) by microscopic examination of epilated lashes. Their corneal manifestation included superficial corneal vascularization (six eyes of five cases), marginal corneal infiltration (two eyes of two cases), phlyctenule-like lesion (one eye of one case), superficial corneal opacity (two eyes of two cases), and nodular corneal scar (two eyes of two cases). After treatment, the Demodex count was reduced from 6.8 +/- 2.8 to 1 +/- 0.9 (standard deviation; P = .001). All patients showed dramatic resolution of ocular irritation, conjunctival inflammation, and all inflammatory, but not scarred, corneal signs; three patients showed improved vision. CONCLUSIONS: A variety of corneal pathologic features together with conjunctival inflammation, commonly noted in rosacea, can be found in patients with Demodex infestation of the eyelids. When conventional treatments for rosacea fail, one may consider lid scrub with tea tree oil to eradicate mites as a new treatment.     

Demodex folliculorum in hair follicles of eyelid skin.

Although Demodex folliculorum is a common inhabitant of eyelid hair follicles, it has received scant attention by ophthalmologists in recent years. I examined 100 biopsies of eyelid skin for the presence of these mites. The incidence of infestation increased with age; 84% of all cases and 100% of cases over age 70 years were involved. No organisms were seen in sebaceous or meibomian glands. I found no pathologic changes except for follicular distention and hyperkeratosis and occasional mild chronic perifolliculitis. Circumstantial evidence for incriminating Demodex in human disease is good, although scientific proof is lacking.     

重视蠕形螨感染与睑缘炎

蠕形螨作为引起睑缘炎可能的病原之一,正逐渐被眼科医生所认识.蠕形螨是人体毛囊和皮脂腺中的一种永久性小型寄生螨,人群体表感染率很高.寄居于人眼睑的蠕形螨分为2种:毛囊蠕形螨和皮脂蠕形螨.蠕形螨生活周期约为14.5d.目前对于蠕形螨感染是否为睑缘炎的病因存在不同的看法.眼科临床医师应深入了解蠕形螨的病原学特征、其与睑缘炎发生的关系、蠕形螨的临床检测方法和阳性结果判定标准,以提高对蠕形螨睑缘炎的临床认识,为该疾病的预防和治疗提供有用线索.     

老年睑板腺功能障碍蠕形螨感染率及茶树精油联合氟米龙的疗效

目的：研究老年睑板腺功能障碍(MGD)蠕形螨感染率及茶树精油联合氟米龙的疗效。

方法：回顾性病例对照研究。选择2017-09/2018-03在宁波市眼科医院门诊就诊的老年MGD患者59例118眼。将睫毛蠕形螨镜检为阳性的38例患者76眼进行症状评分、蠕形螨数量、泪膜破裂时间(BUT)、角膜荧光素染色(FL)、Schirmer I试验(SIaT)等检查,并按不同治疗方法分成3组,A组使用0.02%氟米龙滴眼液滴眼24眼; B组使用茶树精油(TTO)湿巾敷眼26眼; C组用0.02%氟米龙滴眼液滴眼联合TTO湿巾敷眼26眼,随访4wk。

结果：118眼中76眼(64.4%)睫毛蠕形螨镜检为阳性。睫毛蠕形螨阳性的三组患者治疗后的主观症状评分均较治疗前有改善(P<0.05)。治疗后A组蠕形螨数量较治疗前无显著差异(P=0.11); B、C组较治疗前明显减少(均P<0.01)。三组患者BUT治疗前后比较,A组BUT无显著差异(P=0.22); B、C组BUT明显延长(均P<0.05)。治疗后C组的BUT较A、B组明显延长(均P<0.05)。三组患者治疗前后的FL评分均较治疗前明显改善(P<0.05)。

结论：老年MGD患者睫毛蠕形螨感染率较高,睑板腺热疏通后TTO湿巾联合0.02%氟米龙滴眼液能有效驱螨、缓解MGD患者局部症状。     

Chronic blepharitis caused by mite Demodex folliculorum

Two cases of the very long term observation and clinical findings of chronic blepharitis caused by mite Demodex folliculorum are presented. Both patients were treated for over ten years for inflammation of the margin of the eyelid with antibiotics and steroids administered locally. A significant thickening of the blood vessels in the eyelid and numerous cylindrical cuffs of dry discharge around the base of the eyelashes persuaded us to carry out microbiological tests on the suspect eyelashes. In both cases we received additional test results from the epilated eyelashes. Demodex folliculorum should be taken into consideration as an etiological factor in cases of chronic blepharitis.