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December 19, 2015

Demodex - Eye Spiders

Dr. Etty Bitton, OD, MSc
Associate Professor,
Director Université de Montréal,
Dry Eye Clinic

I am sending this note because I discovered your December 7, 2015, editorial when I was searching for a comparison of the effectiveness of Cliradex® and I-lid’n Lash PLUS (I-med pharma). I noted that you mentioned studies on products other than Cliradex have yet to be published, but when I search PubMed I can't find any evaluations of Cliradex or terpinen-4-ol other than articles that say it may be promising. Solid research, Gao et al, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772908/ shows tea tree oil is a promising acaricide when applied at a 50% solution. I can't find anything that indicates the relative strength of terpinen-4-ol in Cliradex and I can't find anything that shows 5% tea tree oil eyelid scrubs eradicate Demodex in the absence of at least two treatments with 50% tea tree oil. I would appreciate your help in pointing me to any research I might have missed as I am desperate to relieve my dry eye syndrome.

I notice that your editorial referred to statistics I've seen quoted elsewhere on the prevalence of Demodex by age. One reason for sending this note is to draw your attention to the research on the prevalence of Demodex when measured by testing for its DNA. Please see Thoemmes et al, http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0106265 If they are correct, 100% of adults are host to Demodex. That also means testing for Demodex by microscopic examination is unreliable and likely a waste of time. I would appreciate receiving your comments on their observations regarding the ubiquity of Demodex and what that implies for treating Meibombian Gland Dysfunction.

I am 68, a retired economist and politician. I was diagnosed with glaucoma three years ago and a year ago I started showing symptoms of dry eye. I am continually reviewing the literature looking for treatments that might relieve my symptoms. I share the best of my review with my ophthalmologist, Dr. Aron Goldberg.

In the past three months my dry eye has become so severe that my daily activities are limited and it is almost impossible for me to go out at night. In November I received LipiFlow treatment with no significant improvement. Last week I received temporary punctal occlusion and have yet to notice any significant benefits. I am using the i-med lubricating eye drops for my dry eye in addition Travoprost and preservative free Timolol for my glaucoma. I seem to be running out of treatment options. I continue to follow the research in the hope that some breakthrough will help those who like me suffer a substantial deterioration in the quality of life due to dry eye, and likely due to our little mite friend, Demodex.

I hope that articles like yours will help to stimulate further research as I’m concerned an industry in treating a chronic progressive condition is beginning to flourish when we need solid evidence based research on effective treatments.

David D. Schreck, Ph.D.
See http://www.strategicthoughts.com

cc: Dr. Aron Goldberg,
North Shore Eye Associates

ps: A copy of this is posted to my website with links to your editorial and to other references in this note.