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EW MEETING REPORTER 138 Reporting from Hawaiian Eye 2018, January 13–19, Maui, Hawaii for a second biometry, and he also stressed discussing the two diseases that the patient will have to deal with. Another case shared was one that Dr. Yoo treated of a 10-year-old boy who had 6 months of intermit- tent redness, swelling, and itching of the right eye. He was treated with topical corticosteroids for atopic conjunctivitis and topical antibi- otics for staph blepharitis with no improvement. Cultures for bacteria and viruses were negative, and his symptoms would wax and wane. The skin exam showed multiple raised papules on the right elbow and knee that was diagnosed as warts by dermatology, Dr. Yoo said, but despite topical salicylic acid and cryotherapy, they continued to spread. Dr. Yoo said she ended up using oral cimetidine treatment, an H2 re- ceptor blocker. She used 40 mg/kg/d for 2 months, and the conjunctivitis and skin lesions resolved. She noted that this issue was contagious and that anyone presenting should be warned to try to avoid close contact with others. The second panel was moderat- ed by Elizabeth Yeu, MD, Norfolk, Virginia, and Marjan Farid, MD, Irvine, California. Panelists included Audrey Talley Rostov, MD, Seattle, Sioux Falls, South Dakota, Preeya Gupta, MD, Durham, North Caroli- na, and Sonia Yoo, MD, Miami. One case discussed was that of a 65-year-old woman referred for cataract evaluation. The patient had glare and blurry vision when read- ing. She was using an artificial tear intermittently and noted that she didn't want to wear distance glasses. Upon clinical exam, it was evident that the patient had mei- bomian gland dysfunction (MGD), positive MMP-9, elevated osmolarity, and other concerns. "We all realize the importance of diagnosing dry eye before cataract surgery," Dr. Gupta said. For anyone who has astigmatism that you'll have to manage as part of making them free of glasses, you have to manage the ocular surface as well, she said. Dr. Gupta said that for a patient like this, she spends extra time explaining that the patient has two issues to address instead of just one. She said that she would put these types of patients on tears, and she has a low threshold to put them on some sort of steroid as well. She noted that she would start topical therapy if she thinks they will have a "long battle with dry eye." Dr. Stonecipher said that he would have the patient come back Diagnosis and treatment of Demodex blepharitis Henry Perry, MD, Rockville Centre, New York, discussed diagnosis and treatment of Demodex blepharitis. Demodex folliculorum is a world- wide skin parasite that is virtually universal in humans by age 45. Infestation occurs when there is invasion of the hair shaft (lash). The diagnosis is relatively simple, but the relationship to an actual etiology of blepharitis is uncertain. Dr. Perry suggested a slit lamp evaluation of the lashes may show this problem. Cylindrical dandruff is between 50% and 80% correlated with Demodex, he added, explain- ing that cylindrical dandruff is pipe stemming of the lash from biofilm, mite carcasses, and keratin debris surrounding the circumference of the lash, beginning at the base. To diagnose these Demodex patients, Dr. Perry said to examine the lashes if there is cylindrical dan- druff. He said to use light microsco- py on a cytology slide. To treat, Dr. Perry suggested using microblepharoexfoliation, lid scrubs, oral ivermectin, and metro- nidazole. Dr. Perry shared information on a Demodex treatment study that he is participating in, which is a prospec- tive randomized double-masked pla- cebo-controlled study of 50 Demodex positive patients. He said he hopes to see further results from the study by next year. Editors' note: Dr. Perry has financial interests with a number of ophthalmic companies. Corneal and external disease: Panel case presentations The medical cornea panel was mod- erated by Terry Kim, MD, Durham, North Carolina, and Francis Mah, MD, La Jolla, California. Panelists included Kenneth Beckman, MD, Columbus, Ohio, Alan Faulkner, MD, Honolulu, Douglas Katsev, MD, Santa Barbara, California, Karl Stonecipher, MD, Greensboro, North Carolina, John Berdahl, MD, February 2018 View videos from Hawaiian Eye 2018: EWrePlay.org Elizabeth Yeu, MD, discusses the role of manual and femto AKs in low levels of astigmatism. Sponsored by

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