Recommendations for Diagnosing and Managing Demodex Blepharitis are Presented in a New Study

An expert panel proposed a pragmatic approach to diagnose and manage Demodex blepharitis in a recent study published in Eye.

Demodex blepharitis is an underdiagnosed and undertreated condition in routine clinical practice, and until recently, ocular Demodex infestation did not have specific diagnostic and management guidelines.

“This study was aimed at developing diagnostic algorithm along with management guidelines that can be used in optometric practice and education for clinical investigation of Demodex blepharitis,” wrote corresponding author Nikhil Sharma, Department of Vision Sciences, Glasgow Caledonian University in Glasgow, Scotland, United Kingdom, and coauthors.

The study on Demodex blepharitis encompassed insights from an expert panel of 11 professionals from the UK, including ophthalmologists, optometrists, and a contact lens optician. It was conducted in 2 rounds of surveys and focused on diagnosing, managing, and treating Demodex blepharitis.

In round one, the panel indicated that Demodex blepharitis is commonly underdiagnosed, with a significant majority (90%) agreeing on the necessity to check for Demodex mites in routine exams. Despite this, 73% of the experts do not follow established guidelines, opting instead for various educational resources to stay informed. The estimated prevalence of Demodex mites in the general population and among those with blepharitis was noted, along with a preference for high magnification for viewing mites. Opinions varied on the role of gender in Demodex prevalence, with a split in beliefs regarding whether males or females are more affected. Associated conditions and risk factors were identified, emphasizing the complexity of managing this condition.

Round 2 maintained a 100% response rate from the initial panel, delving deeper into diagnosis techniques, correlation of signs and symptoms, and treatment approaches. The consensus leaned towards higher magnification for diagnosis and a strong correlation of symptoms in symptomatic patients. Conditions strongly associated with Demodex blepharitis were ranked, highlighting the nuanced understanding of its impact. Treatment preferences leaned toward TTO derivatives, and 72.7% recommended 4 to 6 weeks of treatment. Nearly 73% of the panel recommended 2 to 6 weeks to review patients after starting treatment, and 64% recommended switching to second-line treatment 2 to 6 weeks after unsuccessful first-line treatment.

“We suggest that the diagnostic and treatment algorithms developed in this study could be utilised by eye care practitioners in the UK and beyond in their clinical practices to effectively evaluate and manage Demodex blepharitis,” concluded the study authors.

Reference

Ayres BD, Donnenfeld E, Farid M, et al. Clinical diagnosis and management of Demodex blepharitis: the Demodex Expert Panel on Treatment and Eyelid Health (DEPTH). Eye (Lond). 2023;37(15):3249-3255. doi:10.1038/s41433-023-02500-4