Among control subjects and patients with blepharitis symptoms, hyperopia was observed in 66 and 32 patients, myopia in 14 and 9 patients, and astigmatism in 3 control patients. Moreover, a number of the examined patients had glaucoma (n=12), pseudophakia (n=16), cataract (n=18), chalazia (n=41), anisocoria (n=2), amblyopia (n=3), previous corneal herpes (n=2), and divergent strabismus (n=1). The residents from the Social Welfare Centre were not examined in detail due to their limited cooperation during the examination.
Statistically significant relationships were observed between the and the occurrence of Demodex spp. and the occurrence of burning eyes (p<0.001), eyelash loss (p=0.001), foreign body sensation (p<0.000), conjunctival redness (p<0.001) and tearing (p=0.001), and Demodex spp. infection. Moreover, there was a statistically proven relationship between the blockage of Meibomian glands (p<0.000), chalazia (p<0.001) and cylindrical dandruff (p<0.000).
Physiological flora was found in all patients infected with D. folliculorum with blepharitis and in 9 (8.7%) control subjects (Fig. 1C). The aerobic and facultative anaerobic bacterial flora colonizing conjunctival sacs of the examined patients were found to be Bacillus subtilis, Corynebacterium spp., Diphtheroids spp., Haemophilus influenzae, Micrococcus spp., Penicillium spp., Staphylococcus spp., Streptococcus spp. and Penicillium spp.
Four (3.1%) patients were infected with D. folliculorum had Corynebacteriaceae, three of which also had chalazia.
Only in patients infected with D. folliculorum did we isolate Staphylococcus aureus (9 patients, 7%), Acinetobacter baumannii (one patient, 0.8%), Streptococcus pneumoniae (one patient, 0.8%), Klebsiella oxytoca (one patient, 0.8%), and Bacillus spp. (one patient, 0.8%) in the conjunctival sac. Staphylococcus aureus was observed in an adult male patient with no chronic diseases. In microscopic examination, isolated mature forms of D. folliculorum were observed on the eyelashes (Fig. 1A). Ophthalmic examination showed that the visual acuity (VA) of the right eye and of the left eye were 1.0 and intraocular pressure (IOP) of the right eye was 11.7 mmHg and 10.7 mmHg, respectively. Anterior segment examination using a slit-lamp showed cylindrical dandruff on the upper eyelid and blockage of the Meibomian glands. Staphylococcus aureus was also found in aadult female patientwith arterial hypertension and diabetes mellitus. Microscopic examination of her eyelashes revealed numerous larval and mature forms of D. folliculorum. Ophthalmic examination showed that VA of the right eye was 0.9 and in the left eye was 1.0. Intraocular pressurewas 12.0 mmHg, and 13.0 mmHg, respectively. The patient suffered from irritation of the eye and conjunctiva. Staphylococcus aureus sensitive to erythromycin, clindamycin, gentamicin, neomycin, tetracycline, and trimethoprim/sulfamethoxazole were observed in two patients with mature forms of D. folliculorum. Anadult female patient with thrombocytopenia without ophthalmic symptoms had hyperopia corrected by glasses. Ophthalmic examination showed that VA to be 0.2 in both eyes and IOP was 14.0 and 15.0 mmHg, respectively. Slit lamp examination showed slight follicular irritation of the conjunctiva. In an adult female patient with hyperopia corrected with glasses, VA was 0.6 in the right eye and 0.8 in the left eye. Intraocular pressure was 17.0 mmHg in both eyes. Slit lamp examination showed a cylindrical dandruff on the upper eyelid. Staphylococcus aureus was found in adult male patient from SWH with myopia corrected with eyeglasses. Microscopic examination of his eyelashes revealed mature forms of D. folliculorum. Due to poor cooperation, visual acuity of the eyes was not examined. Intraocular pressure was 14.0 in the right eye and 15.0 mmHg in the left eye. Examination with a slit lamp showed a single cylindrical dandruff on the upper eyelid. Staphylococcus aureus was found in an adult from SWH patient with a chalazion. Microscopic examination revealed isolated mature forms of D. folliculorum. Similarly, visual acuity was not examined due to lack of cooperation, IOP was 15.0 mmHg in both eyes. Slit lamp examination showed irritation of the conjunctiva close to the upper and lower eyelids, and both the upper and lower eyelids were swollen. Additionally, S. aureus was found in an adult SWH resident. Around the patient's eyelashes isolated mature forms of D. folliculorum were found in microscopic examination. Visual acuity was 1.0 in both eyes, while IOP was 9.0 in the right eye and 11.0 mmHg in the left. Examination using a slit-lamp showed no specific symptoms. Methicillin-resistant S. aureus (MRSA) was found in an adult male patient with hyperopia corrected by glasses, hypertension, and atrial fibrillation. Numerous mature forms of D. folliculorum were observed in the patient. Ophthalmic examination showed that VA in both eyes was 1.0 and IOP to be 21.0 in the right eye and 18.0 mmHg in the left. On the upper eyelid, we observed cylindrical dandruff and blockage of the Meibomian glands with an oily secretion at the orifices of the glands; eyelashes were glued together.MRSA was also found in an adult HIV-infected patient from Social Welfare Home in Jaromin. Microscopic examination showed isolated mature forms of D. folliculorum. Intraocular pressure was found to be 11.0 mmHg in both eyes. Slit lamp examination showed pale conjunctiva.
Acinetobacter baumannii was isolated from an adult patient with hypertension. The patient had numerous eggs (Fig. 1B), as well as larval and mature forms of D. folliculorum. Best corrected distance visual acuity was found to be 0.7 in the right eye and 0.6 in the left eye. Intraocular pressure was 20 mmHg in the right eye and 17 mmHg, respectively. The slit lamp test revealed cylindrical dandruff on the upper eyelid.
Streptococcus pneumoniae was found in an adult patient with isolated mature forms of D. folliculorum. Due to poor cooperation, visual acuity of the eyes was not examined. Intraocular pressure was 12.0 in the right eye and 9.0 mmHg in the left eye. The slit lamp study showed cylindrical dandruff, irritation, conjunctival hyperemia, and Meibomian gland dysfunction.
Klebsiella oxytoca were found in an adult patient with hypertension. During microscopic examination of eyelashes, the patient was found to have numerous eggs along with larval and mature forms of D. folliculorum. Ophthalmological examination showed that VA was 0.3 in the right eye and 0.4 in the left eye. Intraocular pressure was 21.0 mmHg in the right eye and 18.0 mmHg in the left eye. In addition, the patient had hyperopia corrected with glasses. The patient complained about tearing and periodical occurrence of chalazia. In the ophthalmological examination, cylindrical dandruff was observed, the eyelashes were stuck together, and the Meibomian glands were found to be obstructed with oily secretion.
Bacillus spp. was found in adult man without chronic diseases. The patient presented with single mature forms of D. folliculorum during microscopic examination. Due to poor cooperation from the patient, vision was not examined, whereas IOP was 14.0 mmHg in the right eye and 21.0 mmHg in the left eye. Slit lamp examination did not show any changes.