Delphi Panel Consensus Regarding Current Clinical Practice Management Options for Demodex blepharitis

Abstract

To obtain consensus on Demodex blepharitis (DB) treatment using a modified Delphi panel process. Methods: Literature search identified gaps in knowledge surrounding treatment of DB. Twelve ocular surface disease experts comprised the Demodex Expert Panel on Treatment and Eyelid Health (DEPTH). They completed a live roundtable discussion in addition to 3 surveys consisting of scaled, open-ended, true/false, and multiple-choice questions pertaining to the treatment of DB. Consensus for scaled questions using a 1 to 9 Likert scale was predefined as median scores of 7-9 and 1-3. For other question types, consensus was achieved when 8 of 12 panelists agreed. Results:The experts agreed that an effective therapeutic agent for treatment of DB would likely decrease the necessity of mechanical intervention, such as lid scrubs or blepharoexfoliation (Median = 8.5; Range 2-9). When treating DB, panelists believed that collarettes serve as a surrogate for mites, and that eliminating or reducing collarettes should be the main clinical goal of treatment (Median = 8; Range 7-9). The panelists would treat patients with at least 10 collarettes, regardless of other signs or symptoms and agreed that DB can be cured, but there is always the possibility for a reinfestation (n = 12). There was also consensus that collarettes, and therefore mites, are the primary treatment target and the way by which clinicians can monitor patient response to therapy (Median = 8; Range 7-9). Conclusion: Expert panelists achieved consensus on key facets of DB treatment. Specifically, there was consensus that collarettes are pathognomonic for DB, that DB patients with >10 collarettes should be treated even in the absence of symptoms, and that treatment efficacy can be tracked by collarette resolution. By increasing awareness about DB, understanding the goals of and monitoring treatment efficacy, patients will receive better care and, ultimately, better clinical outcomes.

Lotilaner Ophthalmic Solution 0.25%: First Approval

“…While ocular itching is the most common symptom of Demodex blepharitis, it can also present with a range of other symptoms like dryness, discharge, eye redness, burning, tearing, foreign body sensation, pain and blurred vision [ 2 ]. The pathognomonic clinical sign of Demodex infestation is the presence of collarettes, which are cylindrical dandruff debris structures that extrude out of the base of the eyelashes and consist of mite waste products and eggs [ 3 ]. The main objective in treating Demodex blepharitis is to eliminate or significantly reduce the presence of collarettes [ 3 ].…”

“…The pathognomonic clinical sign of Demodex infestation is the presence of collarettes, which are cylindrical dandruff debris structures that extrude out of the base of the eyelashes and consist of mite waste products and eggs [ 3 ]. The main objective in treating Demodex blepharitis is to eliminate or significantly reduce the presence of collarettes [ 3 ]. This condition was typically managed with over-the-counter remedies mainly consisting of products based on tea tree oil that are irritating and are toxic to the meibomian glands, with treatment often ineffective [ 2 , 3 ].…”

“…The main objective in treating Demodex blepharitis is to eliminate or significantly reduce the presence of collarettes [ 3 ]. This condition was typically managed with over-the-counter remedies mainly consisting of products based on tea tree oil that are irritating and are toxic to the meibomian glands, with treatment often ineffective [ 2 , 3 ].…”

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

“…4,17 Recently, an expert panel concluded that patients with more than 10 collarettes should be treated, irrespective of symptoms, with reductions in collarettes used to evaluate treatment efficacy. 77 A few studies have used collarette or CD scoring or classification systems to evaluate treatment efficacy. Karakurt et al, 67 for example, graded CD qualitatively as none (0), light (1), moderate (2), or severe (3).…”

“… 29 , 76 An effective treatment for Demodex blepharitis would likely decrease the need for mechanical intervention such as MBE or lid scrubs. 77 …”