Mitigating Challenges Associated With Demodex Blepharitis Diagnosis


Dr Starr provides considerations for navigating diagnostic challenges related to Demodex blepharitis.

Christopher Starr, M.D., FACS: Prior to very recently, one of the biggest challenges with diagnosing Demodex blepharitis was simply the guaranteed kind of diagnosis. The way that diagnosis was guaranteed was if you had a suspicion, if you saw some crusting on the lash or some collarets or what have you, you would have to remove an eyelash or a few eyelashes, pluck them out, which never feels good for the patient, go over to a microscope in the office if you have one, most people didn't. But if you take the ocular surface stuff seriously, you had a microscope, and you had glass slides and cover slips and solution, and you plated the lashes on a microscope and started zooming in and looking for Demodex. [It] takes a while; it's time-consuming. It's costly. You got to have the microscope in the office but not a lot of people have space for an extra microscope. A lot of times you might pluck a few eyelashes and not see them. Then you have these sort of false negative diagnoses. It was cumbersome, it was annoying. A lot of people just never took the time to do it. Demodex was often not diagnosed because of that challenge.

The second challenge has always been this uncomfortable discussion. Infestation, mites, parasitic, ectoparasites, and so on and so forth, a lot of us went into ophthalmology to not have that conversation like that with our patients. When you're having that conversation with somebody, when there isn't an FDA-approved medication to treat it, when there isn't a very effective treatment for it, then that conversation is really uncomfortable. So uncomfortable, I think, and I'm guilty of this, too, you just don't discuss it at all. If there's no treatment for it and you see it everywhere we would recommend the same treatments that we would recommend for everybody with any form of blepharitis: warm compresses… a little baby shampoo on your eyelids, or over-the-counter wipe, maybe an antibiotic here or there, a little ointment, and so on and so forth. Maybe not mention the fact that there are mites. That was very challenging for everybody involved, patients and doctors.

Now that we do have an FDA-approved treatment, we have an effective treatment. Well, I'm much more likely to bring up when I see Demodex and I'm certain that there's Demodex there. We know that collarets now are pathognomonic, that the presence of infestation and you don't have to pluck the eyelashes. You don't need a microscope in your office, you don't need glass slides and all that cumbersome stuff. If you see the collarets, then the best way to diagnose is have the patient look down when you're looking at them under the slit lamp, and they look down, you see the collarets, you've got your diagnosis you've written. It's a very comfortable. It's actually somewhat uncomfortable because anytime you talk about mites and infestation, it's uncomfortable, plain and simple, but it's much more comfortable now that there's a treatment, a prescription medication that can actually treat this extremely effectively, very easily. It's a nice little conclusion to that uncomfortable conversation for us as doctors.

Transcript is AI-generated and edited for clarity and readability.

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