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Demodex Blepharitis Impact On Patient Quality of Life


Christopher Starr, MD, FACS, highlights ways Demodex blepharitis can impact quality of life for affected patients.

Christopher Starr, M.D., FACS: Demodex blepharitis does have a very substantial impact on one’s quality of life for a number of reasons. I would say probably the one of the most important that I see as a practitioner is cosmetics. Demodex blepharitis can have a very significant impact on the way the eyelids look in your eyes, the way your eyes look in general. The eyes can be red, the eyelid margin can be swollen and red and crusty and flaky. That doesn’t look great, and people get very self-conscious about that. It can also lead to loss of eyelashes. We know that people pay a lot of money for their long, full eyelashes, and this condition can lead to loss of those eyelashes, which, of course, has cosmetic implications. Also, the eyelashes are pretty important for protecting the ocular surface. (They keep) irritants out. They’re there for a reason. And when you lose your eyelashes, things can get into your eye, your eyes can be more irritated, and also more wind can get toward the ocular surface and exacerbate or cause dry eye-like symptoms. So there is another reason why it can impact quality of life.

We know that both forms of Demodex blepharitis — follicular and brevis — can lead to recurrent chalazion or hordeolum. When those are present, you have big bumps on the eyelids and, in some cases, it can cause preseptal cellulitis, where the eyelids are very small and in some cases swollen shut and red and inflamed and irritated. Of course, that can have implications as well on quality of life and ocular health, etc. A big study was just done called the ATLAS study, which did look at these variables, the quality of life impact of Demodex blepharitis on a large study of patients. And 47% of patients had difficulty driving at night when they had Demodex blepharitis, 47% were conscious of their eyes all day long, 34% had a difficulty wearing makeup. Of course, that has a major impact on quality of life. (Plus,) 23% thought that their eyes had a negative appearance. Again, it comes back to this cosmetic issue. We know that Demodex blepharitis goes hand in hand with dry eye disease. And dry eye disease can have a major impact on quality of life, on people’s wellness and well-being. It can be very expensive. It can lead to loss of productivity. Finally, we know that when the eyes are inflamed and the eyelids are inflamed, the ocular surface can be inflamed, too. And when there’s inflammation, usually there’s redness. In our post-COVID world, when an eye is red, people jump to the conclusion that one must be infectious, and people tend to back away and keep their distance. I think that also has an impact on quality of life, and there are probably many more. But those were the first ones that pop into my mind.

Transcript edited for clarity.

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