BLOG: Now is the time to ramp up identification, treatment of Demodex blepharitis
Click Here to Manage Email Alerts
Demodex blepharitis is so common that it makes up more than two thirds of all blepharitis cases.
In fact, nearly 58% of patients who visit an eye doctor have pathognomonic Demodex collarettes — a sign that makes it very easy to identify (Trattler W, et al). However, this diagnosis has long been a frustrating one. In the past, we had so few effective, comfortable tools to address Demodex that we were forced to evaluate the benefits of treatment against inflicting emotional distress by breaking the news to patients.
Now everything is changing. With the recent FDA approval of Xdemvy (lotilaner 0.25%, Tarsus), this prescription therapeutic is expected to revolutionize Demodex treatment. Along with current therapies, this new option is driving more optometrists to examine the eyelids for signs of Demodex. Even if you’re planning to ramp up you approach to Demodex with Xdemvy when it becomes available later this month, you can prepare now by diagnosing and treating Demodex blepharitis every time you see it.
Here’s how I’m addressing Demodex blepharitis today and prepping for change in the future.
Make diagnosis routine, efficient
If Demodex blepharitis is symptomatic, patients may have itchy, watery eyes; foreign body sensation; and contact lens intolerance. The condition can also alter manifest refraction, affecting overall clarity and causing fluctuating vision. As a result, some patients with this problem think they have allergies, or their eyeglass prescription is wrong.
Because Demodex blepharitis is so prevalent, we need to make identification a bigger priority — especially as we gain new ways to treat it effectively. Thankfully, diagnosis is easy and fast and requires no special equipment: The presence of collarettes is a pathognomonic sign of Demodex, so that is all we need to identify it. I simply check for collarettes at the base of the eyelashes during the slit lamp exam, starting the exam with a closed eye.
Prepare a treatment plan for today — and tomorrow
I approach Demodex blepharitis with the goal of reducing the infestation and improving symptoms through better hygiene. Although tea tree oil is often recommended to diminish the Demodex overpopulation, some patients are unable to tolerate the currently available tea tree-based products because they can be quite harsh. In-office scurf removal is an option as well, but it’s only a temporary fix if eyelid hygiene is not addressed.
I want my patients to focus long-term on consistently keeping up with eyelid hygiene at home. Lid hygiene improves Demodex blepharitis symptoms, and it will continue to be essential for hygiene after lotilaner 0.25% is available.
I recommend using iVizia micellar eyelid cleansing wipes (Théa Pharma) morning and night to reduce dirt, debris and bacteria on the lids and promote overall cleanliness. The preservative-free cleansing wipes are large, comfortable and soothing to use, with botanicals and zinc, as well as affordable and easy to find in stores.
Many of my patients use iVizia preservative-free tears as well to keep their eyes hydrated and comfortable. Patients are often surprised that I’m recommending products they can easily, affordably purchase at their local stores, and I think using these accessible products improves compliance.
Even after lotilaner 0.25% is available, ocular hygiene will continue to be essential in the management of Demodex blepharitis, which means there’s no reason to put off getting these patients the benefits and comfort of good hygiene practices right now.
Reference:
- Trattler W, et al. Clin Ophthalmol. 2022;doi:10.2147/OPTH.S354692.
For more information:
Jade Coats, OD, is in practice at McDonald Eye Associates, an OD-MD practice in Rogers, Arkansas.
Collapse