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Moderator
María José Cosentino, MD
Panelists
Yong Woo Lee, MD, PhD
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Mark S. Milner, MD
Co-Authors
David Wirta (MD), James Paauw (MD), Michelle Senchyna (PhD)
Purpose
In both pivotal Ph3 studies (COMET-2 and COMET-3), acoltremon 0.003% (ACO; TRYPTYR®) significantly increased natural tear production (based on ?10 mm increase in unanesthetized Schirmer test [UST] score) as early as Day 1. This study further explores ACO-stimulated tear production in each Ph3 study and in a pooled analysis (PA) of both studies.
Methods
Both pivotal Ph3 studies (COMET-2 and COMET-3; N=465 and N=466 respectively), included subjects aged ?30 years with pre-specified signs (staining and anesthetized Schirmer test) and symptoms (Symptoms Assessment iN Dry Eye and ocular discomfort questionnaires) of dry eye disease (DED). At screening, eligible subjects received vehicle (VEH) in both eyes (OU) twice daily (BID) for 14 days. At baseline, re-qualified subjects were randomized 1:1 to receive ACO or VEH, administered BID OU for 90 days. Exploratory endpoints included the percentage of subjects with ?3 mm and ?5 mm increases in UST scores at all visits (Days 1, 7, 14, 28 and 90). Pearson chi-square test was used for analysis.
Results
At baseline (pre-drop Day 1), mean UST scores ranged from 6.2 mm to 6.8 mm for ACO group and 5.9 mm to 6.4 mm for VEH group. As early as Day 1 through Day 90, consistently high responder rates in favor of ACO were observed in both studies and the PA. In the PA, 80.6% to 82.2% of ACO treated subjects achieved a ?3 mm increase in UST scores, compared to 48.4% to 54.7% for VEH treated subjects, yielding a treatment difference of 27.6% to 33.2% (all P<0.0001). Similarly, 71.1% to 76.7% of ACO treated subjects achieved a ?5 mm increase in UST scores, compared to 31.6% to 39.0% for VEH treated subjects, yielding a treatment difference of 35.2% to 45.1% (all P<0.0001).
Conclusion
Acoltremon is a potent TRPM8 agonist. Aligned with its mechanism of action, ACO demonstrated rapid (Day 1), consistent and meaningful increases in natural tear production in a high percentage of subjects. As DED is characterized by tear deficiency, these data support ACO as a novel therapeutic option for managing the signs and symptoms of DED.
Presenting Author
Hajirah N. Saeed, MD, MPH
Co-Authors
Mohammed Almanassra (FRCS), Sila Bal (MD, MPH), Abdelrahman Elhusseiny (MD), James Chodosh (MD, MPH), Husam Dawud (MD)
Purpose
Corneal donation rates remain low across the Muslim world, despite support for corneal transplantation in Islamic theology. Gaza launched a uniquely successful eye banking program (EBP) in August 2022. We evaluated Gaza's EBP as a model for sustainable cornea procurement and transplantation in the Muslim world and to assess the impact of war.
Methods
In this descriptive, observational study, data regarding eye banking and corneal transplantation between August 2022 and June 2025 at Gaza Eye Hospital, historically the sole transplant center in Gaza. Data were drawn from surviving records and the senior author's archives after significant war-related data loss. Parameters included procurement, storage, outcomes, and barriers.
Results
Gaza's EBP was launched in 2022 and included public health messaging and cultural, religious, and community level engagement to increase societal investment in organ donation. From August 2022-October 2023, ~330 corneas were procured after family consent and used for penetrating keratoplasty. Infectious disease testing was performed on the donor prior to procurement. Tissues were stored in Optisol, and transplanted within a mean of 3 days. Indications included advanced keratoconus, corneal scar, bullous keratopathy, and dystrophy. No infections occurred; early graft failure was seen in 3 cases (1%). From October 2023-June 2025, conflict halted all elective surgeries.
Conclusion
Gaza's EBP demonstrates that with public health outreach and religious backing, eye banking can thrive in resource-poor Muslim contexts. This replicable model can serve >25% of the world's population. However, instability and conflict remain threats to sustainability, underscoring the need for international support and resilient infrastructure.
Presenting Author
Meltem Yashar, MD
Co-Authors
Laura Di Meglio (OD), Ugur Tunc (MD), Felipe Barandiaran (BSc), Sezen Karakus (MD), Anthony Gonzales (OD)
Purpose
Belantamab mafodotin, an antibody-drug conjugate used in the treatment of multiple myeloma, is associated with a high incidence of keratopathy, most often presenting as microcyst-like epithelial changes (MECs). We describe the spectrum of corneal findings in this patient population and highlight a distinctive case with a marked refractive shift.
Methods
We retrospectively reviewed medical records of patients with multiple myeloma treated with belantamab and evaluated at the Wilmer Eye Institute between 2020 and 2022. Demographics, treatment course, visual acuity, and corneal findings were collected, and ocular complications related to therapy were analyzed
Results
Twelve patients (3 male/9 female; median age, 68 years; range, 55-89) received 1-6 belantamab infusions (median, 3). MECs developed in 5 patients (42%), typically after ?2 infusions, with 4 experiencing decreased vision. One patient with prior radial keratotomy (RK) exhibited a pronounced myopic shift of approximately 9-10 diopters, leading to a decline in uncorrected visual acuity from 20/20 to 20/400-20/600, accompanied by topographic changes and a distinctive fluorescein staining pattern around the RK incisions. Following discontinuation of belantamab, corneal findings and most of the refractive shift improved within two months.
Conclusion
Belantamab therapy can cause clinically significant corneal complications. While MECs are most common, prior corneal surgery such as RK may predispose to more severe visual changes, including refractive shifts. Close ophthalmic monitoring in patients receiving belantamab is essential, particularly those with prior corneal surgeries.
Presenting Author
Sangeeta Abrol, MS, MPH, MBA
Co-Authors
Nishi Satish (MBBS, MS)
Purpose
The purpose of this prospective study is to determine if intraoperative aphakic biometry in patients with dense cataracts yields accurate intraocular lens power calculation as compared to a scan biometry predicted for the same patients.
Methods
A total of 109 patients were included in this study done over a period of 3 months. Patients worked up for cataract using the IOL master 500 and in patients where the IOL master was unable to yield accurate axial length readings, A scan ultrasound biometry was done, and an iol power was predicted. Once cataractous lens was removed, the wounds were hydrated ensuring no rise in IOP, and IOL master analysis was repeated on these patients once aphakic. The new axial length was then used to calculate the IOL power using the Barrett universal II formula and the IOL was placed. The predicted refraction with a scan biometry done before was then compared with the aphakic biometry refraction.
Results
The refractive predictive error using intraoperative biometry was negligible. Most patients experienced emmetropia for distance. The refractive predictive error between A scan biometry and intraoperative biometry was statistically and clinically significant.
Conclusion
Intraoperative, or in our , case per-operative biometry allowed us to give premium postoperative results to patients attending a government hospital with minimal resources. It is an innovative and specially developed method to provide economically challenged patients with the gift of emmetrop
Presenting Author
Haoyu Wang, MD
Co-Authors
Alfonso Iovieno (MD, PhD, FRCSC)
Purpose
Chronic corneal neovascularisation (CNV) and lipid keratopathy (LK) respond poorly to topical corticosteroids and frequently relapse after treatment discontinuation. This case series reports the long-term use of topical tacrolimus in resolving chronic CNV and LK.
Methods
A retrospective review was conducted using the electronic database of a single corneal specialist's practice at the Eye Care Centre, University of British Columbia, Vancouver.
Results
6 patients (mean age:57 years;50% female) with chronic CNV and LK were identified. Underlying aetiologies included herpes simplex virus keratitis (n=3), varicella zoster virus keratitis (n=2), and idiopathic interstitial keratitis (n=1). At initiation of topical tacrolimus 0.03% twice daily, mean best-corrected visual acuity was 0.43 LogMAR, improving to 0.38 LogMAR at final follow-up. BCVA improved or remained stable for all six patients. The mean treatment duration was 19 months (range: 12-36 months). Regression of CNV and LK was observed in all six patients at 12 months, as confirmed by clinical examination and slit-lamp photography. No significant ocular adverse effects were noted.
Conclusion
This case series demonstrates that prolonged use of topical tacrolimus can achieve regression or resolution of chronic CNV and LK without significant ocular side effects. A minimum treatment duration of one year is recommended for optimal outcomes. ?
Presenting Author
Eliane Rozanes, MSc
Purpose
This study aims to share the valuable lessons learned from our initial experience with osteo-keratoprothesis (OKP) surgery in patients with ocular cicatricial pemphigoid (OCP). We address the challenges encountered during this complex procedure to provide insights for surgeons beginning their journey in performing OKP in this patient demographic.
Methods
We conducted a retrospective case series involving five OCP patients who underwent OKP as a last-resort intervention for visual salvage at Rabin Medical Center between 2010 and 2024. All procedures were performed by the same, experienced team of ophthalmologic and orthopedic surgeons. Patient demographics, surgical details, and postoperative complications were meticulously recorded.
Results
All patients successfully underwent OKP; however we encountered the following complications: • Three patients experienced poor mucosal graft integration and required multiple grafting procedures, including skin grafts. • One patient developed corneal keratitis, necessitating a hot graft transplant, along with additional treatment for an epiretinal membrane and cystoid macular edema through steroid injections and pars plana vitrectomy. This patient later faced device extrusion attributed to osteopenia. • Another patient experienced a psychotic episode following vision restoration. • One patient demonstrated mucosal overgrowth over the optic device and developed scratches on the optic lens.
Conclusion
OKP represents a transformative surgical option for restoring sight in patients with OCP. Complications can arise from all parts of this surgery. These experiences underscore the necessity for highly skilled surgical teams in managing such intricate cases and highlight the importance of thorough preoperative evaluation and postoperative care.
Presenting Author
Itay Lavy, MD
Co-Authors
David Smadja (MD), Benjamin Stern (MD), Nir Erdinest (PhD, BScOptom), Edward Averbukh (MD), Nadav Shemesh (MD, MHA)
Purpose
This study evaluated the therapeutic potential of topical Ripasudil hydrochloride hydrate in managing various forms of corneal edema
Methods
Retrospective study. 96 patients of 72.20 ± 10.52 years, 53 females (55.2%) who were treated with Ripasudil for corneal edema, with a mean treatment duration of 5.2 ± 2.3 months, divided into four groups: post-cataract surgery (n = 32), Fuchs endothelial corneal dystrophy (FECD; n = 29), post-DMEK (DMEK; n = 25), and post-penetrating keratoplasty (PKP; n = 10). All patients were treated with Ripasudil in the following months. Clinical efficacy outcomes where best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell count (ECC) with specular microscopy, anterior segment optical coherence tomography (OCT), slit-lamp examination and intraocular pressure (IOP)
Results
Ripasudil treatment led to a reduction in CCT and improvement in visual acuity across most groups, with minimal changes in ECC. CCT decreased by 30.44 ?m (p < 0.001), 25.56 ?m (p < 0.001), 8.41 ?m (p = 0.05), and 6.80 ?m (p > 0.1); visual acuity improved by 0.27 (p = 0.001), 0.18 (p = 0.02), 0.17 (p = 0.025), and 0.07 logMAR units (p > 0.1); and ECC changed by +7.0 (p > 0.1), 15.4 (p > 0.1), -7.6 (p > 0.1), and 2.3 cells/mm2 (p > 0.1) in the post-cataract surgery, FECD, post-DMEK, and post-PKP groups, respectively
Conclusion
No adverse events or progression of edema were recorded during the follow-up period. These findings support the role of Ripasudil as a non-invasive pharmacological approach to managing corneal edema and delaying or possibly avoiding surgical interventions, such as corneal transplantation, in selected cases.
Presenting Author
Isilay Kavadarli, MD
Co-Authors
Iskender Solmaz (MD), Canan Gur (PhD), Oguz Kul (PhD)
Purpose
To investigate the safety, telomerase reverse transcriptase (TERT) activity, and ocular pharmacokinetics of cycloastragenol (CAG) in human corneal endothelial and epithelial cells, and to determine its potential to penetrate the cornea as a therapy for telomere-related cellular senescence.
Methods
The cytotoxicity and efficacy of varying CAG concentrations were assessed in corneal endothelial and epithelial cells through IC50 determination, and TERT activity was measured at sub-IC50 concentrations by indirect immunofluorescence with an anti-TERT antibody. Transcorneal passage was evaluated using a 3D organotypic cornea model, while in vivo rabbit studies assessed absorption and tissue distribution after topical application. CAG concentrations in ocular tissues were quantified by LC-MS/MS.
Results
CAG exhibited low cytotoxicity, with IC50 values of 220 µM in corneal endothelial cells and 740 µM in corneal epithelial cells. Sub-IC50 concentrations caused minimal apoptosis or necrosis, with significant TERT activity observed from 2 µM. In 3D organotypic models, transcorneal passage was dose-dependent, ranging from 0.18-0.25% at 24 h to 1.89% at 72 h with repeated dosing. In rabbits, peak CAG levels (Tmax) occurred at 30 min, with Tmax values of 215.56 ng in corneal tissue (mean 162.99 ng), 4 ng in the anterior chamber (mean 2.56 ng), and 14.12 ng in the iris (mean 9.41 ng). Tear levels declined rapidly due to turnover. Overall ocular absorption was 5.39%, with 0.35% reaching the iris.
Conclusion
CAG is safe at therapeutic doses, activates TERT in corneal endothelial and epithelial cells, and efficiently penetrates the cornea to reach intraocular tissues. These findings suggest that CAG may serve as a potential therapeutic approach to reduce age-related decline in corneal endothelial and epithelial cells.
Presenting Author
Eric D Kim, MD
Co-Authors
Martin Calotti (MD), Julia Haller (MD), Christine Chung (MD), Allen Ho (FACS, MD), Randy Calotti (BSc), Ankur Nahar (MD), Turner Wibbelsman (MD), Collin Richards (MD), Luis Acaba-Berrocal (MD)
Purpose
To describe the clinical characteristics, management, and visual outcomes within the largest reported cohort of Orbeez gel-blaster projectile injuries to date, highlighting the critical importance of preventive measures and appropriate safety messaging.
Methods
Retrospective case review of sixty eyes in fifty-nine patients presenting to the Wills Eye Emergency Department with ocular injuries caused by Orbeez gel-blaster projectiles between June 1st, 2021, and April 1st, 2025. The majority of patients were male (n=45, 75%) and ? 18 years of age (n=30, 50.0%) with mean ± standard deviation (SD) of 24.6±12.9 years.
Results
At presentation, mean visual acuity (VA) was 20/32 and mean intraocular pressure (IOP) 14.8 mmHg; seven (11.9%) eyes had IOP > 21 mmHg. Zero patients wore eye protection. Most eyes (n=53; 88.3%) had an Ocular Trauma Score (OTS) of 100. Most common diagnoses were traumatic iritis (n= 30; 50.0%), hyphema (n=25; 42%), and commotio retinae (n=16; 26.7%). Younger age (? 21 years) was associated with presence of commotio (P = 0.036). Of the 23 (38.3%) eyes with follow up, mean ± SD follow-up interval was 46.4±78.9 days. Mean final VA was 20/28. Three (5.0%) eyes underwent intervention including cataract extraction (n=1, 1.7%), anterior chamber washout (n=1, 1.7%), and laser retinopexy (n=1, 1.7%).
Conclusion
Orbeez-related ocular injuries cause significant ocular trauma, some requiring surgical intervention. Given the ocular injuries and outcomes described in this study, we emphasize the importance of eye protection for anyone in the vicinity of gel-blaster projectiles.
Presenting Author
Ahmad Kunbaz, MD
Co-Authors
Mohamad Tarek Madani (BSc), Hajirah Saeed (MD, MPH), Ahmad Al-Moujahed (MD), Buraa Kubaisi (MRCSEd), Nuha Alfayumi (MBBS), Basel Tarab (MD, MHA)
Purpose
Following the fall of Syria's Baathist regime and resultant opportunities to expand health services, we quantified the keratoplasty backlog at Syria's largest tertiary eye hospital and identified data-driven priorities for creating a sustainable national eye-banking program.
Methods
We conducted a retrospective review of medical records from the Surgical Eye Hospital in Damascus between January 1997 and April 2025. Extracted data included the number of patients identified as requiring keratoplasty, the number and type of procedures performed at SEH, procedures completed externally, cancellations, and laterality of disease. The primary outcome was the proportion of patients and eyes remaining untreated over the study period. Secondary outcomes included the proportion of patients receiving keratoplasty at SEH versus other institutions and the overall eye-level coverage rate. All records were in the form of paper charts and were all reviewed to ensure completeness.
Results
A total of 9,764 patients required keratoplasty. Of these, 1,602 underwent transplantation at SEH (16.41%) and 309 at external institutions (3.16%). 594 were canceled (6.08%), and 7,259 remained untreated (74.35%). Among 8,861 patients managed at SEH, 3,992 (45.05%) had unilateral disease and 4,869 (54.95%) bilateral disease, totaling 13,730 eyes in need of keratoplasty. 1,602 keratoplasties (11.67% of eye-level demand) were performed at SEH. With the addition of the 309 cases performed externally, overall coverage was 13.92% (1,911/13,730). A backlog of 11,819 eyes (86.08%) remained. All cases relied on tissue imported from abroad.
Conclusion
Syria faces a substantial keratoplasty shortfall, with the vast majority of affected eyes remaining untreated. These findings support the urgent development of a sustainable, locally supported eye-banking program combined with standardized training and quality assurance to ensure effective corneal transplantation services.
Presenting Author
Abbie Lai, MD
Co-Authors
Saama Sabeti (MD, MPH, FRCSC), David Rabinovitch (MD), Tushar Dave (MD), Andrew Samuel (MD), Kashif Baig (MD, MBA)
Purpose
To evaluate whether procedure-specific educational videos (pterygium excision and conjunctival autograft procedure (PECA), superficial keratectomy (SK)) improve patient comprehension, satisfaction and readiness before procedures. Further, assess the relationship between objective knowledge retention and subjective confidence measures in patients.
Methods
Single-centre quality improvement study of 67 patients (42 PECA, 25 SK) from October 2023-August 2024. Inclusion: adults ?18 years scheduled for PECA/SK with English proficiency. Exclusion: visual/hearing/cognitive impairment. Patients viewed procedure-specific videos before surgery then completed validated questionnaires: satisfaction (9 items), comprehension (9 items), readiness (18-item composite), educational quality (4 items), all scaled 0-100. Secondary outcome: objective knowledge test (5 MCQs). Analysis: descriptive statistics, t-tests (procedure, gender, medical background), ANOVA (age, education), Pearson correlations for objective-subjective relationships. Significance: p<0.05.
Results
Mean of all scores >80%: satisfaction 83.0 ± 15.8 (95% CI, 79.1-86.8), comprehension 82.7 ± 13.9 (95% CI, 79.3-86.1), overall readiness 82.8 ± 14.3 (95% CI, 79.3-86.3) and educational quality 83.8 ± 14.4 (95% CI, 80.3-87.3). 72% achieved ?4/5 correct answers for objective knowledge. Significant negative correlation between objective knowledge and subjective confidence (r = -0.243, p = 0.046), consistent with the Dunning-Kruger effect. PECA videos scored significantly higher than SK (p = 0.027). No significant differences in scores based on demographics (age, sex, education, medical background). Lowest ratings for postoperative concerns, questions addressed and decision confidence.
Conclusion
Educational videos achieved >80% patient satisfaction and comprehension for minor ophthalmic procedures. The inverse correlation between objective knowledge and subjective confidence highlights a need for both measures. Results support video education as a feasible adjunct to standard counseling, with future optimization of specific content.
Presenting Author
Lauren A. Nakhleh, MD
Co-Authors
Hajirah Saeed (MD, MPH), Charles Bouchard (MD, MA)
Purpose
Eyelid and periorbital (EP) burns can cause significant cicatricial changes leading to severe ocular surface disease. In this study, we sought to characterize patient demographics and acute outcomes in patients undergoing amniotic membrane transplantation (AMT) to the EP following ocular adnexal burns.
Methods
In this prospective observational study, we included 9 patients (13 eyes) treated with AMT to the EP skin following periocular burns. Collected data included demographics, burn type and severity, affected eye, and clinical outcomes including discharge time, epithelialization, and complications.
Results
Of 9 patients, 6 (66.7%) were male. Racial distribution was White (5, 55.6%) Black (2, 22.2%), and Hispanic (2, 22.2%). Burns were bilateral in 4 cases (44.4%) and unilateral in 5 (55.6%). Injury type included thermal (8, 88.9%) and scald (11.1%). Burn severity was mixed partial-thickness in 6 (66.7%), and 1 each (11.1%) of deep dermal, mixed, or full-thickness. Mean admission duration was 17.5 days; mean time to re-epithelialization 26.8 days, longer with greater burn severity and TBSA (p<0.001). One eyelid required repeat AMT. All re-epithelialized by discharge without need for skin grafting. Hypopigmentation was common, milder than surrounding untreated skin in the majority of cases.
Conclusion
These findings support amniotic membrane as a reconstructive tool in burn-related ocular adnexal injury that may prevent ocular surface sequelae. Future studies involving larger and comparative cohorts will allow assessment of long-term visual and functional outcomes.
Presenting Author
Uma Yogesh Thigale, MBBS, MS
Purpose
To assess and compare the cost benefit and improvement in the Quality of life of the patients undergoing corneal transplant surgery at secondary health centres (SHC) and a tertiary health centre (THC) in South India
Methods
A retrospective observational study was done over a period of six months, wherein 50 corneal transplant patients across 4 SHC were compared with age and gender matched 50 corneal transplant patients from THC. Demography, clinical history, expenditure incurred, treatment and outcome were obtained from the electronic medical records and analysed. The data was entered in MS EXCEL spreadsheet and analysed using Statistical Package for Social Sciences (SPSS) version 21.0. A p value of <0.05 was considered statistically significant.
Results
There was a significant improvement in the BCVA in both centres(P<0.05). In comparison to THC, the mean overall expenditure for travel, accommodation and the surgery was significantly lesser at SHC (Rs 10413.4 vs 34643.2, P=0.0002). At SHC, the average distance from home being 110 km, as compared to distance from the nearest tertiary centre which was 215km,was significantly lesser.At SHC, the number of follow up visits were significantly more (15.56 vs 11.04, P=0.009), also an indicator of more compliant treatment with the advantage of early detection of complications and timely intervention whenever needed
Conclusion
Availability of health care centre to the rural people at their doorstep, can be more cost effective with a better clinical outcome. The convenience in terms of proximity, cost effectiveness, early management of complications and regular treatment followups can make corneal transplant popular amongst the rural population
Presenting Author
David Mikhail, BSc
Co-Authors
Daniel Milad (MD), Fady Sedarous (MD), Louis Vaudoisey (MD), Jonathan El-Khoury (MD), Samir Jabbour (MD, FRCSC), Mona Harissi-Dagher (MD, FRCSC)
Purpose
To evaluate whether a cornea-specialized large language model (LLM) enhanced with retrieval-augmented generation (RAG) improves clinicians' diagnostic and management accuracy in complex corneal cases compared to a general-purpose GPT-4o model and unaided clinician performance.
Methods
This prospective, randomized, masked evaluation study involved three cornea trainees who independently reviewed 39 real-world corneal cases under three experimental conditions: unaided, GPT-4o-assisted, and assisted by a cornea-specialized GPT-4o model. The cornea-specialized model was constructed by embedding over 200 publicly available Wikipedia articles into GPT-4o's RAG framework. Ophthalmologists provided open-ended diagnoses and selected the next-step management options (multiple choice). They were allowed up to three GPT-4o queries per case, and the AI-assisted arms were randomized to minimize bias. Accuracy for both tasks was compared against experts using McNemar's test.
Results
Diagnostic accuracy was 48.7%, 20.5%, and 38.5% unaided, improving to 69.2%, 46.2%, and 59.0% with general GPT-4o (p<0.04). The cornea-specialized GPT-4o further improved accuracy to 71.8%, 48.7%, and 74.4%, with improvements over unaided performance for all clinicians (p<0.01). For next-step decisions, unaided accuracy was 76.9%, 87.2%, and 59.0%. With the specialized model, Ophthalmologist 3 improved to 71.8% (p<0.05), Ophthalmologist 1 remained high at 82.1%, and Ophthalmologist 2 declined to 64.1% (p<0.05).
Conclusion
A cornea-specialized LLM enhanced with RAG improved diagnostic accuracy in complex corneal cases, particularly for lower baseline performance. Effects on management accuracy were inconsistent. Future studies should explore the use of open-ended management tasks and examine whether curated retrieval corpora yield better model performance.
Presenting Author
Eric D. Rosenberg, DO, MSE
Co-Authors
Nicole Fram (MD), James Mun (PhD), Elizabeth Yeu (MD), Takako Kiener (PharmD), Alanna Nattis (DO)
Purpose
Demodex blepharitis is an inflammatory eyelid disease due to Demodex mite infestation, which may act as vectors for bacterial pathogens. This systematic literature review (SLR) aimed to identify the frequency and types of co-infested Demodex species and culturable ocular bacteria in patients with Demodex blepharitis (DB).
Methods
A systematic search of MEDLINE (via PubMed) and EMBASE was performed to identify literature published from inception to July 10, 2025. Included studies examined co-infestation by Demodex species and culturable ocular bacteria in DB patients. Studies that examined co-infestations limited to fungi and/or viruses, non-culturable microorganisms, or organisms not detected on the ocular surface were excluded. Studies that reported qualitative outcomes without quantitative data or protocols, letters, opinions, and reviews were also excluded. Screening was conducted by two independent investigators, with discrepancies resolved by a third investigator, as needed.
Results
Of 509 references, 507 title/abstracts and 26 full texts were screened, and 10 studies were included. The frequency of ocular bacteria co-infested with Demodex was highly variable, ranging from 18%-100% in DB patients. Among 6 studies reporting bacterial species, Cutibacterium acnes (range 2.15%-84.4%), Staphylococcus epidermidis (1.49%-51.1%), Staphylococcus aureus (7%-40%), and Bacillus oleronius (47.4%-52.6%) were most frequently reported. In studies that compared DB patients with healthy controls, the presence of C. acnes and B. oleronius was significantly higher in DB group compared to controls, and one study isolated Klebsiella oxytoca only in DB patients and not in healthy controls.
Conclusion
This SLR identified that co-infestation with culturable ocular bacteria in patients with Demodex blepharitis was high and varied across studies. These findings support the relationship between Demodex mites as vectors for bacteria. Targeted anti-Demodex therapy may be effective in patients with Demodex blepharitis co-infested with bacteria.
