Effect of acaricidal therapy on eyelid microcirculation

Background. The high prevalence of Demodex-associated blepharitis underscores the importance of studying eyelid microcirculation. Laser Doppler flowmetry (LDF) provides an objective method for assessing microcirculatory changes during therapy.

Purpose: To assess treatment-associated changes in eyelid microcirculation during acaricidal therapy in patients with mixed Demodex blepharitis and to determine their value for monitoring treatment efficacy.

Materials and methods. The study included 48 patients (96 eyes; mean age, 64.7 ± 5.1 years) diagnosed with chronic mixed Demodex blepharitis. Patients were divided into three equal groups (16 patients, 32 eyes each). All participants underwent a standard ophthalmic examination, completed the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire to assess and quantify symptoms, and had laboratory testing of the eyelid margins for the presence of Demodex mites. In Group 1, treatment included a cosmeceutical preparation containing wormwood (Artemisia) extract and a lipid-containing tear substitute instilled three times daily for 1.5 months. Group 2 received a cosmetic eyelid cream containing a 2-methyl-nitroimidazole derivative in combination with a tear substitute, and Group 3 used an eyelid gel containing sulfo-concentrol. Eyelid microcirculation (MC) parameters were evaluated by LDF at baseline and after 1 week, 1.5 months, and 3 months of therapy.

Results. After 7 days of treatment, changes in Group 1 were more pronounced than in Groups 2 and 3, which showed mainly a reduction in the contribution of passive microcirculatory regulatory mechanisms. The wormwoodbased gel demonstrated anti-inflammatory and circulation-stimulating effects on the eyelids. A decrease in the shunting index indicated a reduction in blood flow velocity through arteriolovenular anastomoses and tissue ischemia, accompanied by moderate enhancement of vasomotor microvascular activity. Preservation of compensatory microcirculatory processes was reflected in high modulation of blood and lymph flow. These microcirculatory changes were accompanied by improved quality-of-life scores (SPEED) in Groups 1 and 2 and by a reduction in Demodex infestation in Group 1. Longitudinal observation demonstrated moderate activation of tissue metabolism and regulatory system activity with a marked decrease in tissue ischemia in Group 1, whereas in Groups 2 and 3, the role of active microcirculatory regulatory mechanisms was reduced.

Conclusion. Conservative treatment of mixed Demodex blepharitis induces measurable changes in eyelid microcirculation, supporting the importance of microcirculatory monitoring as an objective tool for evaluating therapeutic efficacy.

1. Shah PP, Stein RL, Perry HD. Update on the Management of Demodex Blepharitis. Cornea. 2022;41(8):934–939. doi: 10.1097/ICO.0000000000002911

2. Rhee MK, Yeu E, Barnett M, et al. Demodex Blepharitis: A Comprehensive Review of the Disease, Current Management, and Emerging Therapies. Eye Contact Lens. 2023;49(8):311–318. doi: 10.1097/ICL.0000000000001003

3. Pyzia J, Mańkowska K, Czepita M, et al. Demodex Species and Culturable Microorganism Co-Infestations in Patients with Blepharitis. Life (Basel). 2023;13(9):1827. doi: 10.3390/life13091827

4. Moris García V, Valenzuela Vargas G, Marín Cornuy M, Aguila Torres P. Ocular demodicosis: A review. Demodicosis ocular: una revisión. Arch Soc Esp Oftalmol (Engl Ed). 2019;94(7):316– 322. doi: 10.1016/j.oftal.2019.04.003

5. Akkucuk S, Kaya OM, Aslan L, et al. Prevalence of Demodex folliculorum and Demodex brevis in patients with blepharitis and chalazion. Int Ophthalmol. 2023;43(4):1249–1259. doi: 10.1007/s10792-022-02523-y

6. Murphy O, O’Dwyer V, Lloyd-McKernan A. The Clinical Use of Eyelash Manipulation in the Diagnosis of Demodex folliculorum Blepharitis. Eye Contact Lens. 2020;46 Suppl 1:S33–S38. doi: 10.1097/ICL.0000000000000608

7. Aumond S, Bitton E. Palpebral and facial skin infestation by Demodex folliculorum. Cont Lens Anterior Eye. 2020;43(2):115–122. doi: 10.1016/j.clae.2019.09.001

8. Tas AY, Mergen B, Yildiz E, et al. Interobserver and Intraobserver Agreements of the Detection of Demodex Infestation by in Vivo Confocal Microscopy. Beyoglu Eye J. 2022;7(3):173– 180. doi: 10.14744/bej.2022.37880

9. Sędzikowska A, Tarkowski W, Moneta-Wielgoś J, et al. Effect of ocular demodicosis on the stability of the tear film and the tear break up time. Sci Rep. 2021;11(1):24296. doi: 10.1038/s41598-021-03801-y

10. Zor’kin AA. The influence of the composition of conservative therapy on changes in sonographic parameters of blood flow in patients with ischemia threatening limb loss due to diabetes mellitus. Innovative aspects of the development of science and technology. 2021;11:173–179 (In Russ.).

11. Korolev AI, Fedorovich AA, Gorshkov AYu, Drapkina OM. Microcirculation of the skin with essential arterial hypertension. Regional blood circulation and microcirculation. 2020;19(2):4– 10 (In Russ.). doi: 10.24884/1682-6655-2020-19-2-4-10

12. Tsepov LM, Nikolaev AI, Petrova EV, Nesterova MM. Pathogenetic substantiation of clinical use of medicines in complex therapy for inflammatory periodontal diseases (literature review). Periodontology. 2018;2:4–11 (In Russ.). doi: 10.25636/PMP.1.2018.2.1

13. Safonova TN, Kintukhina NP, Sidorov VV. Treatment of chronic blepharitis. Russian Annals of Ophthalmology. 2020;136(1):97– 102 (In Russ.). doi: 10.17116/oftalma202013601197

14. Safonova TN, At’kova EL, Kintyuhina NP, Reznikova LV. Modern methods of studying the morphofunctional state of the eyelids with dysfunction of the meibomian glands. Russian Annals of Ophthalmology. 2018;134(5):276–281 (In Russ.). doi: 10.17116/oftalma2018134051276

15. Fedorovich AA, Loktionova YI, Zharkikh EV, et al. Body Position Affects Capillary Blood Flow Regulation Measured with Wearable Blood Flow Sensors. Diagnostics (Basel). 2021;11(3):436. doi: 10.3390/diagnostics11030436

16. Safonova TN, Kintyukhina NP, Sidorov VV, Gladkova OV. Laser doppler flowmetry in assessing the effectiveness of treatment of chronic demodex blefaritis. Russian Ophthalmological Journal. 2017;10(2):62–66 (In Russ.).

17. Safonova TN, Kintyukhina NP, Yartsev VD. Morphofunctional substantiation of repeated invasive treatment of chronic blepharitis. Russian Annals of Ophthalmology. 2021;137(1):21– 27 (In Russ.). doi: 10.17116/oftalma202113701121

18. Safonova TN, Zaitseva GV, Kintyukhina NP. The effect of a new coronavirus infection caused by the SARS-CoV-2 virus on microcirculation in the conjunctiva. Medical Council. 2022;(14):206–211 (In Russ.). doi: 10.21518/2079-701X2022-16-14-206-211

19. Kazantseva EP, Frolov AM, Frolov MA, et al. The role of systemic diseases in the etiology of chronic blepharitis. Point of view. East-West. 2023;2:62–65 (In Russ.). doi: 10.25276/2410-1257-2023-2-62-65

20. Alkharki L, Yusef YuN, Budzinskaya MV, et al. Current capabilities of anterior segment optical coherence tomography. Russian Annals of Ophthalmology. 2024;140(2-2):190–195 (In Russ.). doi: 10.17116/oftalma2024140022190

21. Kiseleva TN, Saakyan SV, Makukhina VV, et al. Use of optical coherence tomography angiography in assessment in conjunctival vascular architecture in health and pathology. Russian Annals of Ophthalmology. 2022;138(6):32–42 (In Russ.). doi: 10.17116/oftalma202213806132

22. Krechina EK, Frolova OA, Grudyanov AI, et al. Indicators of periodontal hemomicrocirculation in patients with chronic and aggressive periodontitis in dynamics after conservative and surgical treatment. Dentistry for All. 2018;3:60–67 (In Russ.).

23. Kunin AA, Oleinik OI, Kubyshkina KP. Antimicrobial effect of medical ozone on periodontal tissues in various methods of its application. Periodontology. 2018;3:84–89 (In Russ.). doi: 10.25636/PMP.1.2018.3.15

24. Lyubomirsky GB. Monitoring the provision of physiotherapy in the Republic of Udmurtia patients with periodontal disease and compliance to her patients on periodontal treatment. Institute of Dentistry. 2018;2:30–32 (In Russ.). doi: 10.25636/PMP.1.2018.4.11

25. Medvedev IB, Trubilin VN, Poluninа EG, et al. Modern Ideas about Dysfunction of the Meibomian Glands. Ophthalmology in Russia. 2022;19(2):359–367 (In Russ.). doi: 10.18008/1816-5095-2022-2-359-367

26. Chen D, Wang J, Sullivan DA, et al. Effects of Terpinen-4-ol on Meibomian Gland Epithelial Cells In Vitro. Cornea. 2020;39(12):1541–1546. doi: 10.1097/ICO.0000000000002506

27. Sakhnov SN, Yanchenko SV, Malyshev AV, et al. Eyelid hygiene in preparing dry eye patients for cataract surgical treatment. Russian Annals of Ophthalmology. 2020;136(6):177–182 (In Russ.). doi: 10.17116/oftalma2020136062177

28. Yanchenko SV, Malishev AV, Teshaev ShZh, et al. Acaricidal therapy in chronic demodex blepharitis and meibomian gland dysfunctions. Russian Annals of Ophthalmology. 2023;139(5):36–42 (In Russ.). doi: 10.17116/oftalma202313905136

29. Liu L, Yang S, Zhu M, et al. Improved Watershed AlgorithmBased Microscopic Images Combined with Meibomian Gland Microprobe in the Treatment of Demodectic Blepharitis. Comput Math Methods Med. 2022;2022:4389659. doi: 10.1155/2022/4389659

30. Drozdova EA, Mikhailova EV. Individual Approach to the Treatment of Complicated Forms of Blepharitis: from Theory to Practice. Ophthalmology in Russia. 2020;17(4):830–837 (In Russ.). doi: 10.18008/1816-5095-2020-4-830-837

31. Sibogatova EV, Mal’tseva TI, Selivanova EA, Latypova EA. About the diagnosis and treatment of demodectic blepharitis (review). Orenburg medical bulletin. 2021;9(4):12–14 (In Russ.).

32. Safonova TN, Kintyukhina NP, Petrenko AE, Gladkova OV. First experience of “Deksodem phyto” use in treating chronic demodex blepharitis. Point of view. East-West. 2016;1:145–147 (In Russ.).