International Ophthalmology

, Volume 37, Issue 1, pp 303–312 | Cite as

Demodex species in human ocular disease: new clinicopathological aspects

  • Stephen G. Nicholls
  • Carmen L. OakleyEmail author
  • Andrea Tan
  • Brendan J. Vote


Demodex brevis and Demodex folliculorum are likely ubiquitous organisms associated with human eyelashes. However, they have also been implicated in the pathogenesis of external ocular diseases. This article reviews the current literature in regards to life cycle, morphology, pathogenesis and treatment of underlying Demodex spp. infestation and outlines the previously undescribed in vivo behaviour of the mites. Images were obtained from the epilation of lashes from 404 patients seen in clinical practice. Epilated lashes were placed on a microscope slide which had been coated with optically clear hypromellose/carbomer gel (Genteal gel, Novartis pharmaceuticals corporation, East Hanover, New Jersey). Adults were identified with either dark field or standard transmission microscopy at 40–100×. Eggs and other life-cycle stages were examined at 250× magnification, with transmission microscopy giving the best image resolution. The life cycle of the mite has been reviewed and simplified according to clinical observations. Clinical signs suggestive of underlying Demodex spp. infestation have been described, and their pathogenesis was explained based on the micrographic digital images obtained. The problem of symptomatic Demodex spp. disease likely reflects an imbalance in the external ocular ecology; however, the role of Demodex spp. as a commensal should not be overlooked. Treatment should not be aimed at total eradication of the mite but rather restoring the ocular ecology to a balanced state. By revisiting the life cycle of the mite, we can identify areas where possible intervention may be effective.


Demodex External ocular disease Dry eye disease Blepharitis 


Author Contributions

SGN was involved in study design, acquisition of data, analysis of data, manuscript preparation and final approval of manuscript. CLO was involved in data analysis, literature review, manuscript preparation and final approval of manuscript. AT was involved in data analysis, literature review and final approval of manuscript. BJV was involved in data analysis, manuscript preparation and final approval of manuscript.

Compliance with ethical standards

Conflict of interest

There are no competing interests to declare in regards to this research, from any author.


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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Stephen G. Nicholls
    • 1
    • 2
  • Carmen L. Oakley
    • 3
    • 4
    Email author
  • Andrea Tan
    • 3
  • Brendan J. Vote
    • 3
  1. 1.Tasmanian Eye ClinicsGlenorchyAustralia
  2. 2.Menzies Research InstituteHobartAustralia
  3. 3.Tasmanian Eye InstituteSouth LauncestonAustralia
  4. 4.Save Sight InstituteUniversity of SydneySydneyAustralia

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