d 6 is a rare occurrence. As stated previously, Demodex is highly photophobic and avoids light. Coston11 writes that he has seen hundreds of mites appear in severely infested lids but has never seen a mite emerge completely.
Two modern techniques allow imaging of Demodex in vivo. Sattler et al.34 used confocal laser scanning microscopy to view lesional skin in 25 patients with rosacea. If imaged partially sideways, the mites were detected as lengthy cone-shaped structures similar to their appearance under the light microscope.34 The high-definition optical coherence tomography imaging is another new technique for detecting mites. The detection rate of Demodex mites by high-definition optical coherence tomography in infested patients was significantly higher than in healthy controls.36 Maier et al.36 imaged 20 rosacea patients and found 192 mites versus 13 mites seen in the control group. Both techniques are noninvasive compared with traditional methods such as epilation or skin biopsy.
Demodicosis can manifest itself in many patients in different ways and needs to be diagnosed properly.42 To paraphrase Forton et al.,33 although Demodex are greatly underdiagnosed, they nevertheless concern the daily practice of the eye care professional.
Milton M. Hom
1131 East Alosta Ave
Azusa, CA 91702
We acknowledge Jerry Paugh, Alan Sasai, and Leonard Bielory for their encouragement and enthusiastic support.
Received February 4, 2013; accepted March 6, 2013.
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