Demodex Blepharitis in a Contact Lens Wearer

EP: 1.Detecting Demodex Blepharitis during preop cataract surgical visit

EP: 2.Preop Visually Significant OSD: Treatment Strategy and Outcomes

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EP: 3.Demodex Blepharitis in a Contact Lens Wearer

EP: 4.Demodex Blepharitis in a Contact Lens Wearer: Treatment Plan and Outcomes

Young Adult with Contact Lens Intolerance and Recurrent Chalazia

The diagnostic approach to younger patients with contact lens intolerance requires systematic evaluation for multifactorial ocular surface disease, as illustrated by a 35-year-old female presenting with recurrent chalazia and progressive contact lens wear difficulties. Her chief complaints included lid margin erythema, morning lid fatigue, cosmetic intolerance, and limited contact lens wearing time. Relevant medical history included prior isotretinoin therapy for adolescent acne, diagnosed facial rosacea managed intermittently with oral doxycycline, and multiple chalazia. Despite her symptomatic presentation, point-of-care testing revealed normal tear osmolarity (300-305 mOsm/L) without significant inter-eye variability, and negative MMP-9 testing, demonstrating the limitations of relying exclusively on aqueous and inflammatory markers in patients with predominantly lipid and microbiological pathology. This diagnostic finding underscores the importance of comprehensive clinical examination in all symptomatic patients, regardless of point-of-care test results.

Slit lamp examination revealed multiple lid margin abnormalities including meibomian gland dysfunction with thick, toothpaste-like secretions, poor expressibility, and visible pitting from previous chalazia. Meibography demonstrated areas of gland attenuation and frank dropout. Ocular rosacea was evidenced by lid margin telangiectasia, while anterior blepharitis presented as visible biofilm and pathognomonic cylindrical collarettes at the lash bases, confirming Demodex infestation. Tear film evaluation showed reduced tear meniscus height and inferior corneal staining consistent with evaporative mechanisms. This constellation of findings resulted in multiple concurrent diagnoses: rosacea-associated evaporative dry eye, moderate meibomian gland dysfunction with poor expression, Demodex blepharitis, history of recurrent chalazia with resultant meibomian gland structural damage, and contact lens intolerance—illustrating the typically multifactorial nature of ocular surface disease in clinical practice.

The comprehensive evaluation identified Demodex blepharitis as a significant contributing factor to the patient's recurrent inflammatory pathology. The presence of collarettes—cylindrical waxy deposits at the lash base containing mite waste products—represents the pathognomonic sign of Demodex folliculorum infestation. Smaller Demodex brevis mites typically inhabit meibomian glands, potentially contributing to gland dysfunction, inspissation, and recurrent chalazia. This case exemplifies the broader clinical significance of Demodex beyond simple anterior blepharitis, illustrating its role in contact lens intolerance, cosmetic intolerance, and recurrent inflammatory lid disease. The diagnostic approach emphasizes the importance of thorough lid margin evaluation in all patients with ocular surface symptoms, even when point-of-care testing for aqueous deficiency and inflammation appears normal.