Metronidazole treatment of demodex b leph aro conjunctivitis in ocular rosacea - A case report

Purpose. Blepharoconjunctivitis is the commonest clinical manifestation of ocular rosacea. Presence of Demodex folliculorum, considered to be a causative agent of rosacea, is proved by cilia epilation. Complications and differential diagnosis include dry eye syndrome, sebotrheic blepharitis, bacterial blepharo- and ceratoconjunctivitis as well as allergic conjunctivitis. Local treatment involves eyelid scrubs with mild baby shampoo and application of mercury ointment, duration is limited to 6 weeks under frequent clinical control due to corneal toxicity of mercury. Methods 30-year-old female patient with complaint of red, irritated eyes over 21 years resistant to antibiotic and anti-allergic treatment. General medical history unremarkable, mercury allergy Acuity. R/L 20/20. Biomicroscopy: red, thickened eyelid margins with crusty debris on ratified and partially broken eyelashes, telangiectatic blood vessels along the anterior eyelid margins on all 4 lids, cilia epilation positive for Demodex f., hyperemic conjunctiva, low tear meniscus, further ophthalmplogic examination unremarkable Diagnosis: Demodex blepharoconjunctivitis. Results Specific treatment with mercury ointment was contraindicated due to allergy. Alternatively recommended oral minocycline 100 mg daily over one month neither alleviated symptomes nor reduced Demodex/ prevalence. Topical application of 2 % metronidazole on lid margin after lid scrub with baby shampoo twice daily relieved symptoms and halfed number of mites after one month, eyelashes grew again after 2 months. Local treatment was discontinued after 6 months when Demodex f. was unprovable. No relapse occurred in 6 months follow-up. Conclusions Local application of 2% metronidazole is a new and effective alternative treatment for Demodex blepharoconjunctivitis Neither ocular nor systemic side effects were detected. Oral minocycline showed no improvement in this case Clinical studies are planned to further evaluate the treatment none.