How should ocular mites in humans be treated? - briefly
Effective management requires topical acaricidal agents such as 1 % ivermectin or 0.1 % milbemycin ointment applied to the affected eye, combined with meticulous eyelid hygiene and debris removal. Systemic therapy may be added for extensive infestation, and follow‑up microscopy confirms eradication.
How should ocular mites in humans be treated? - in detail
Ocular demodicosis requires accurate identification, appropriate pharmacologic intervention, mechanical debridement, and preventive measures.
Diagnosis begins with slit‑lamp examination. Microscopic evaluation of epilated eyelashes reveals the presence of Demodex folliculorum or Demodex brevis. Positive findings are confirmed by counting mites per lash (≥ 3 mites per 5 lashes is considered significant).
Pharmacologic therapy focuses on agents that eradicate the mites and reduce associated inflammation:
- Topical ivermectin 1 % cream or gel applied twice daily for 2–4 weeks.
- Tea‑tree oil (0.5 %–1 % concentration) in a sterile ophthalmic vehicle, administered twice daily.
- Permethrin 5 % ointment applied to the lid margins for 10 minutes, then rinsed, repeated every 48 hours for three cycles.
- Oral ivermectin 200 µg/kg single dose, repeated after one week for refractory cases.
Mechanical removal complements medication:
- Lid hygiene with warm compresses (5–10 minutes) to liquefy secretions.
- Gentle expression of cylindrical dandruff using a sterile cotton swab.
- Blepharotomy with a fine sterile blade to excise heavily colonized follicles when topical treatment fails.
Adjunctive anti‑inflammatory treatment includes:
- Topical corticosteroid drops (e.g., loteprednol 0.5 %) for short‑term control of conjunctival hyperemia.
- Non‑steroidal anti‑inflammatory eye drops (e.g., ketorolac 0.5 %) to reduce discomfort.
Environmental and lifestyle measures reduce reinfestation risk:
- Daily lid scrubs with diluted baby shampoo or commercial lid‑cleansing pads.
- Replacement of pillowcases, towels, and eye makeup every 2–3 days.
- Avoidance of oily cosmetics that create a favorable habitat for the mites.
Monitoring involves re‑examination at 4‑week intervals. Persistence of mites after two treatment cycles warrants escalation to oral therapy or referral to a specialist. Successful management results in resolution of blepharitis, reduction of ocular surface inflammation, and restoration of visual comfort.