My most popular Youtube video

A couple of years ago, I decided to put a few videos up on Youtube. They were nothing spectacular, and were meant partly as a record of what I have been doing in the clinic, and some others were to demonstrate surgical techniques.

It became apparent within the first year that one of the videos was different. It was getting thousands of hits, while the others were languishing with perhaps a few tens of views.

This is the video: http://www.youtube.com/watch?v=16bSxfCS0wI

It did not have sound. It was about cleaning the eyelids of mucky crusts, and of looking for tiny little mites called demodex. And as of today it has 392456 hits...

I think it boils down to the frustration many patients and doctors feel about the problem of blepharitis and the lack of effectiveness of many of the traditional treatments. When I was training, and even nowadays, a commonly taught technique was to clean the eyelids with diluted baby shampoo. The idea was to use the shampoo to help remove crusts, while it was gentle enough not to irritate the eye even if any of it went in.

However, it made little to no difference for many blepharitis sufferers. The crusts would return almost as quickly as they were removed, and the eyes would often remain irritated and itchy.

About 10 years ago, Scheffer Tseng and others began reporting research done on demodex mites and blepharitis. That piqued my interest and I started looking for them in my patients. I started finding them in many, many people...

Although the mites don't always cause trouble, they certainly have the potential to do so. Back when I first started to become aware of them, I remember a lady who had very bad persistent eye irritation that was resistant to all the dry eye treatments she had been prescribed. I happened to see her and noticed her blepharitis. Remarkably, she felt much better after a single dose of oral Ivermectin that I prescribed. In more recent years, a number of patients did not seem to respond to the oral medication, and finally I asked a compounding pharmacy to produce a topical preparation which has proved very effective. What appears to be current 'mainstream' treatment, tea tree oil, proved to be very irritating for my patients as well as not being very effective at killing the mites.

It turns out that many viewers of my video (and readers of this blog as well...thanks for reading!:)) live outside of Singapore, with many in the United States and Europe. Some viewers have asked about the availability of Ivermectin cream, and unfortunately it is not commercially available at the moment. However, Galderma has recently concluded phase 3 studies for the use of topical Ivermectin in rosacea, and the hope is that this will become commercially available soon.

At least in terms of medical videos on Youtube, it doesn't appear that you always need special effects or a South Korean origin to be popular!

P/S: since that first successful video, I made a more detailed one describing the detection of demodex in the eyelashes as well as the treatment of this stubborn condition, at this address:  http://youtu.be/NskwR1XzTtE