Demodex Blepharitis: A Comprehensive Review of the Disease, Current Management, and Emerging Therapies

Abstract

Demodex blepharitis is a common disease of the eyelid, affecting approximately 25 million Americans. This article reviews what is known about the mechanisms and impact of Demodex blepharitis, risk factors, signs and symptoms, diagnostic techniques, current management options, and emerging treatments. Demodex mites contribute to blepharitis in several ways: direct mechanical damage, as a vector for bacteria, and by inducing hypersensitivity and inflammation. Risk factors for Demodex blepharitis include increasing age, rosacea, and diabetes. The costs, symptom burden, and psychosocial effects of Demodex blepharitis are considerable. The presence of collarettes is pathognomonic for Demodex blepharitis. Redness, dryness, discomfort, foreign body sensation, lash anomalies, and itching are also hallmarks of the disease. Although a number of oral, topical, eyelid hygiene and device-based options have been used clinically and evaluated in studies for the management of Demodex blepharitis, none have been FDA approved to treat the disease. Recent randomized controlled clinical trials suggest that lotilaner ophthalmic solution, 0.25%, is a topical treatment with the potential to eradicate Demodex mites and eliminate collarettes and eyelid redness for an extended period.

FIG. 1.

Demodex folliculorum is found in human skin, especially the cheeks, nose, and eyelids. Image courtesy of Patrick Vollmer, OD.

FIG. 2.

Collarettes, the pathognomonic sign of Demodex blepharitis, can be readily identified at the base of the upper lash margin on downward gaze at the slitlamp. Image courtesy of Patrick Vollmer, OD.

FIG. 3.

Symptoms reported by patients with confirmed Demodex blepharitis ( N=301).