Diagnostic and Therapeutic Challenges in Blepharokeratoconjunctivitis Associated with Demodex Infestation: A Case-Based Review

This report details two illustrative cases of marginal keratitis that were initially misdiagnosed as viral keratitis, underscoring the critical diagnostic and therapeutic challenges in such scenarios. The first case describes a 4-year-old girl who presented with recurrent episodes of redness and photophobia previously managed under the assumption of viral etiology. Re-evaluation revealed blepharokeratoconjunctivitis secondary to Demodex mite infestation. Adjustments to the treatment regimen resulted in significant clinical improvement. The second case involved a 27-year-old woman with a chronic history of presumed herpes simplex virus keratitis. A revised diagnosis of Demodex blepharitis led to the successful integration of ivermectin and topical steroids into the treatment plan. These cases highlight the importance of considering alternative diagnoses, such as blepharokeratoconjunctivitis, in patients with recurrent keratitis symptoms. Accurate diagnosis is crucial as it influences management decisions and enhances patient outcomes, emphasizing the need for vigilance and a comprehensive diagnostic approach in clinical practice.