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The Association of Demodex with Chalazia: A Histopathologic Study of the Eyelid

Schear, Matthew J. D.O., M.S.; Milman, Tatyana M.D.; Steiner, Tehilla M.D.; Shih, Carolyn M.D., M.B.A.; Udell, Ira J. M.D.; Steiner, Anne M.D.

Ophthalmic Plastic & Reconstructive Surgery: July/August 2016 - Volume 32 - Issue 4 - p 275–278
doi: 10.1097/IOP.0000000000000500
Original Investigations

Purpose: To investigate the association of Demodex with chalazia and to describe the associated histopathologic changes in the eyelid tissue.

Methods: In a retrospective histopathologic case–control study, 78 ectropion/entropion repair eyelid wedge resections were examined. Serial sections were obtained on formalin-fixed, paraffin-embedded tissues, stained with hematoxylin-eosin and studied by light microscopy. Thirty-eight patient specimens had evidence of chalazia and 40 did not. The main outcome measures included quantification of total eyelid hair follicles, meibomian glands, Demodex folliculorum and Demodex brevis; determining the presence of lipogranulomatous and non-lipogranulomatous inflammation, hair follicle and meibomian gland duct dilatation and hyperkeratinization, and meibomian gland acinar dilation, keratinization, and atrophy.

Results: There was a significantly greater mean number of D. folliculorum in biopsies with chalazia, when compared with biopsies without chalazia (5.55 vs. 2.68, p = 0.044). The presence of D. folliculorum was strongly associated with hair follicle duct dilatation and hyperkeratinization and with perifollicular nongranulomatous inflammation (p = 0.00). Hair follicle duct dilatation, hyperkeratinization, and perifollicular inflammation were also independently associated with chalazia (p = 0.040 and 0.031, respectively). D. brevis was observed only in meibomian glands with chalazia (mean = 0.342), but this finding did not reach statistical significance; p= 0.068.

Conclusion: While the authors cannot establish causality between Demodex and chalazia, these findings suggest that D. folliculorum indirectly may be involved in the pathogenesis of chalazia via its effect on the anterior eyelid margin.

Demodexfolliculorum eyelid infestation and not Demodexbrevis was significantly associated with the presence of chalazia in our histopathologic controlled study.Supplemental Digital Content is available in the text.

*New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York; The New York Eye and Ear Infirmary of Mount Sinai, New York, New York; and Department of Ophthalmology, North Shore-Long Island Jewish Health System, Hofstra North Shore-LIJ School of Medicine, Great Neck, NY

Accepted for publication March 2, 2015.

Supported in part by the New York Eye and Ear Infirmary pathology department research fund.

Presented at the annual meeting of The Association for Research in Vision and Ophthalmology on May 8, 2014 in Orlando, FL.

The authors have no financial or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address correspondence and reprint requests to Anne Steiner, M.D., Department of Ophthalmology, North Shore-Long Island Jewish Health System, 600 Northern Blvd Suite 218, Great Neck NY 11021. E-mail:

© 2016 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.