Pilocarpine Gel for the Treatment of Demodicosis???A Case Series

BACKGROUND: Excessive numbers of the mite, Demodax folliculorum, in the eyelash follicies cause itching and is referred to as demodicosis. We evaluated 4% pilocarpine gel as a treatment for this condition. METHODS: An advertisement was placed in a retirement home newsletter, requesting persons with ocular discomfort. Respondents were examined for Demodex and persons with abundant mites were invited to participate. One eye was treated with pilocarpine gel; the other eye was untreated. The relative abundance of mites was evaluated at baseline, after 1 and 2 weeks of treatment. Subjects kept a daily log of symptoms. RESULTS: Eleven of 22 persons with ocular itching had abundant Demodax. Mites were reduced significantly by the treatment (p = 0.017). The amount of mite reduction was closely correlated with the extent to which itching was alleviated (r = 0.811, p = 0.008). CONCLUSION: Abundant Demodex is an important cause of ocular itching in older persons. Mites can be reduced with pilocarpine gel and itching alleviated.