Ivermectin-metronidazole therapy successful in treating blepharitis
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Ivermectin-metronidazole combined topical gel therapy successfully treated blepharitis caused by Demodex folliculorum infection, according to study results published in Contact Lens and Anterior Eye.
“Demodex folliculorum is a microscopic, elongated mite, which is considered to be the most prevalent ectoparasite in humans. ... The eyelid can also be infected, leading to blepharitis,” Marcel Y. Avila, MD, PhD, department of ophthalmology, Universidad Nacional de Colombia, and colleagues wrote. “Numerous compounds have been described for the treatment of these infections. ... Development of a novel therapeutic approach to eradicate this mite with minimal adverse events and maximum tolerability is required.”
Avila and colleagues conducted a randomized clinical trial comprising 60 patients with diagnosed Demodex-associated blepharitis. They assigned patients to receive either topical ivermectin (0.1%)-metronidazole (1%) gel treatment or vehicle at day 0, day 15 and day 30. Researchers evaluated patients for the number of Demodex spp. mites found on the eyelashes as well as clinical improvement and adverse events.
Study results showed complete eradication of Demodex spp. in 96.6% of treatment group patients with decreases in Demodex count from day 15 to day 30 (P .001). Further, investigators also saw a statistically significant improvement in symptoms and reduction in redness in the treatment group (P .001). In the control group, there was no change in Demodex counts.
“This topical approach seems to be superior to systemic treatment, also having a better safety prole and posing less risk to patients,” Avila and colleagues concluded. “Application of this gel for the treatment of dierent parasitic infections of the eyelids could be feasible; this requires further exploration.”
Perspective
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Justin Kwan, OD, FAAO
In this study, the authors demonstrated safety and efficacy of a novel ophthalmic preparation to reduce Demodex numbers in patients presenting with cylindrical dandruff. Although symptoms were an inclusion criteria, the questionnaire used was not stated. Presumably, the ivermectin 0.1% plus metronidazole 1% was applied evenly to the lid margins on day 0 and 15, and as a gel, has a longer retention time than any commercial tea tree oil formulations.
This synergistic formulation has been shown to deliver what both patients and doctors want in reduction of symptoms, redness and Demodex counts. It is able to be more effective than systemic ivermectin because the medication is topically applied at the site of infestation. For cases not responding to traditional tea tree oil, this in-office treatment and potentially at-home treatment can be pulsed to resolve any flare ups and keep the patient comfortable. Indirectly, meibomian gland dysfunction may also improve when Demodex brevis numbers are also reduced.
At the end of the day, the clinician has to decide when Demodex infestation is not responding, recalcitrant and requires the next step in treatment. Demodex is often not an isolated condition, and other ocular surface and/or systemic diseases should be addressed concurrently.
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