Updates in the Management of Demodex Blepharitis - Episode 4

Lack of Guidelines Impacting Demodex Blepharitis Treatment Landscape

A lack of guidelines impair the management of Demodex blepharitis.

Douglas K. Devries, OD: As we look at the prevalence of Demodex blepharitis, there have been no formal treatment guidelines developed for Demodex blepharitis. There are several reasons why this has occurred. No. 1 is the lack of an effective treatment until fairly recently. Another is a lack of identification. If providers haven’t been taught how to identify it, then it’s going to be irrelevant whether there’s a treatment and what the treatment guidelines are. With the awareness that we’re seeing now and beginning to see on the disease state, I think a consensus treatment guideline will be developed.

As a result of not having good guidelines for diagnosis, we see a lack of treatment and therefore a lack of control of the economic burden that may be on our patients. There’s a direct correlation. When you don’t have guidelines, you don’t look. As a result of that, you have more of the Demodex blepharitis that can adversely affect patients and therefore cause a greater economic burden. Whether that’s in loss of productivity or medical treatment for the wrong condition, both things are going affect the patients. The lack of guidelines at this point has an impact on the economics of Demodex blepharitis.

We don’t have an FDA-approved treatment for blepharitis. In the absence of that, we’re typically using agents that we hope will at least stagnate or perhaps clean some of the biofilm and remove some of the Demodex. For years, we’ve used tea tree oil in various compounds, wipes, or direct tea tree oil. Twelve years ago, I was ordering tea tree oil from a compounding pharmacy to apply directly to the patient’s eyelids. The tea tree oil had an impact on the Demodex, but the treatment was very cumbersome. It had a lot of toxicity. You had to finish that treatment with a course of steroids because you’d have to calm the inflammation that occurred on the cornea. After that, the tea tree oil was compounded into a different wipe, which had very limited efficacy. We were stopping some of the peaks or proliferation, or at least holding it down and trying to manage.

One of the more effective treatments has been microblepharoexfoliation, which completely removes the food source. The food source is a polysaccharide found in biofilm. If you can eliminate that food source, then you hold down the supply because of the physiology. When Demodex has a food source and the patient is providing that through the biofilm, it tends to proliferate. There’s mechanical means to do that. A lack of availability in all practices keeps people from having guidelines, treating patients, or acquiring that type of treatment.

Transcript edited for clarity.