Clinical Efficacy of Polyhexamethylene Biguanide Lid Scrub on Demodex Blepharitis

Jun Hyung Moon; Jae Chan Kim

doi:10.3341/jkos.2014.55.4.493

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Moon and Kim: Clinical Efficacy of Polyhexamethylene Biguanide Lid Scrub on Demodex Blepharitis

Original Article

J Korean Ophthalmol Soc 2014;55(4):493-497.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.4.493

Clinical Efficacy of Polyhexamethylene Biguanide Lid Scrub on Demodex Blepharitis

Jun Hyung Moon, MD, Jae Chan Kim, MD, PhD

Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea

Address reprint requests to Jae Chan Kim, MD, PhD Department of Ophthalmology, Chung-Ang University Hospital, #102 Heukseok-ro, Dongjak-gu, Seoul 156-755, Korea, Tel: 82-2-6299-1665, Fax: 82-2-825-1666 E-mail: Jck50ey@kornet.net

Received 23 September 201324 October 2013 Accepted 4 March 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the treatment efficacy of polyhexamethylene biguanide (PHMB) lid scrub on Demodex blepharitis.

Methods

Thirty-one patients diagnosed with Demodex blepharitis were evaluated every 2 weeks during 8 weeks of lid scrub treatment with 0.4% PHMB. Patients underwent epilation of 4 eyelashes in each eye, and the number of Demodex lesions was counted. The patients answered questionnaires regarding ocular surface discomfort and underwent ophthalmologic exams including slit lamp and tear breakup time (TBUT). Compliance was recorded as 1 of 3 stages (good, moderate, poor).

Results

One patient was excluded for poor compliance. After PHMB lid scrub for 8 weeks, Demodex count was reduced in 28 of 30 patients (pre-PHMB 7.9 ± 3.6 counts, post-PHMB 2.2 ± 2.4 counts, p < 0.01). In addition, TBUT showed a statistically significant increase after PHMB lid scrub (pre-PHMB 2.7 ± 0.8 seconds, post-PHMB 3.4 ± 0.9 seconds, p < 0.01). Ocular surface disease index (OSDI) score was reduced in 28 of 30 patients (pre-PHMB 22.0 ± 10.7 points, post-PHMB 7.4 ± 6.0 points, p < 0.01).

Conclusions

Eight weeks of treatment with polyhexamethylene biguanide lid scrub on Demodex blepharitis had good treatment efficacy for reducing Demodex counts and OSDI scores and increasing TBUT.

Keywords: Demodex blepharitis, Polyhexamethylene biguanide

References

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Figure 1.

Photograph demonstrating ocular Demodex in Demodex blepharitis. Demodex Brevis, Demodex folliculum and eyelash observed by optical microscope (×100).

Table 1.

Age, ocular Demodex counts, OSDI score, and TBUT with Demodex blepharitis

	Male (n = 17)	Female (n = 13)	p-value
Age (years)	54.0 ± 14.7	50.2 ± 13.7	0.483^*
Demodex counts	9.1 ± 3.5	7.0 ± 3.6	0.065^*
TBUT (second)	2.6 ± 0.8	2.8 ± 0.8	0.483^*
OSDI score	20.8 ± 11.1	23.6 ± 10.4	0.457^*

Values are presented as mean ± SD.

TBUT = tear break up time; OSDI = ocular surface discomfort index.

^* Mann-Whitney U-test.

Table 2.

Demodex counts, OSDI score according to age

Age (years)	Number	Demodex counts	OSDI score
20-39	7	6.4 ± 1.5	21.1 ± 4.6
40-59	12	7.1 ± 3.5	21.4 ± 10.2
60<	11	9.7 ± 4.2	23.3 ± 14.2

Values are presented as mean ± SD.

OSDI = ocular surface discomfort index.

Table 3.

Demodex counts, OSDI score, and TBUT before and after PHMB treatment in Demodex blepharitis

	Pre PHMB (n = 30)	Post PHMB (n = 30)	p-value
Demodex counts	7.9 ± 3.6	2.2 ± 2.4	<0.01^*
TBUT (second)	2.7 ± 0.8	3.4 ± 0.9	<0.01^*
OSDI score	22.0 ± 10.7	7.4 ± 6.0	<0.01^*

Values are presented as mean ± SD.

PHMB = polyhexamethylene biguanide; TBUT = tear break up time; OSDI = ocular surface discomfort index.

^* Wilcoxon signed rank test.

Table 4.

Demodex counts and OSDI score before, after PHMB treatment 2, 4, 8 weeks

	Before	Post PHMB (2 weeks)	Post PHMB (4 weeks)	Post PHMB (8 weeks)
Demodex counts	7.9 ± 3.6	5.9 ± 2.9	3.3 ± 2.7	2.2 ± 2.4
OSDI score	22.0 ± 10.7	19.3 ± 9.5	12.0 ± 8.2	7.4 ± 6.0
p (Demodex counts)		<0.01^*	<0.01^*	<0.01^*
p (OSDI score)		0.006^*	<0.01^*	<0.01^*

Values are presented as mean ± SD.

Post hoc test = Bonferroni.

PHMB = polyhexamethylene biguanide; OSDI = ocular surface discomfort index.

^* Repeated measure ANOVA.

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