AJMC outlines Demodex blepharitis strategies

AJMC published a July 11, 2024 review that recasts Demodex blepharitis as a condition eye clinics can identify and treat through routine lid-margin examination rather than a vague ocular-surface complaint. The article, part of the publication's “Updates in the Management of Demodex Blepharitis” supplement, says the disease is common, often underdiagnosed and increasingly relevant in cataract and other high-volume practices. It points readers to collarettes at the base of the eyelashes as the key clinical sign and places the first FDA-approved drug, Xdemvy, at the center of current treatment options. The review also ties diagnosis and treatment to practical outcomes such as symptom relief, cleaner preoperative measurements and patient satisfaction. ### Why are ophthalmologists paying closer attention to Demodex blepharitis now? AJMC said Demodex blepharitis affects “up to 57.7%” of patients visiting U.S. eye clinics, citing a retrospective subgroup analysis of 1,032 patients seen at six clinics. The review says that prevalence, combined with overlapping symptoms such as itching, burning, crusting and lash loss, has pushed the condition higher on clinicians’ diagnostic lists. (ajmc.com) Mile Brujic, an optometrist interviewed in the same AJMC supplement, said the Trattler findings changed how clinicians looked for the disease in practice. Brujic said awareness increased over the prior two years and that once clinicians began checking more actively, prevalence appeared “much higher than previously thought.” ### What are clinicians supposed to look for at the slit lamp? I. Benjamin Gaddie, an optometrist speaking at the SECO 2025 meeting in Atlanta, told AJMC that diagnosis begins with having the patient look down while the examiner inspects the base of the lashes for collarettes. (ajmc.com) Gaddie said that once a collarette is seen, it is “pathognomonic” for Demodex blepharitis and no other diagnostic test is usually needed. (ajmc.com) AJMC's July 2024 review similarly centers lid-margin assessment. The article says Demodex mites can be present without disease, but blepharitis becomes clinically relevant when infestation is associated with signs and symptoms and with complications including dry eye disease, meibomian gland dysfunction, conjunctivitis, punctate keratitis and chalazion. ### Why does this show up in cataract and ocular-surface workups? (ajmc.com) AJMC's review says Demodex blepharitis can distort the broader ocular-surface picture and complicate care when it is missed. The article specifically links targeted treatment to better symptom control, cataract biometry and postoperative satisfaction, placing the condition inside routine pre-surgical workflow rather than outside it. (ajmc.com) The same supplement tracks that message across multiple interviews with eye-care specialists. AJMC's series includes segments on diagnosis in clinical practice, differential diagnosis, payer approval, and other treatment considerations, reflecting how the condition is being folded into standard ocular-surface management. ### What changed on treatment after 2023? The U.S. Food and Drug Administration approved Xdemvy, lotilaner ophthalmic solution 0.25%, in July 2023 for Demodex blepharitis. (ajmc.com) FDA labeling identifies the drug as an ectoparasiticide and directs one drop in each eye twice daily, about 12 hours apart, for six weeks. AJMC's review says earlier approaches often relied on tea tree oil or terpinen-4-ol cleansers, while the current landscape includes a therapy that directly targets the mites. (ajmc.com) Gaddie told AJMC that in his practice the six-week course works “quickly,” and said nearly eight in 10 patients dropped to 10 or fewer collarettes from a baseline of about 150. ### What does the article say about access and next steps? (accessdata.fda.gov) AJMC's coverage does not present treatment as frictionless. Gaddie said access to Xdemvy can require prior authorizations and coordination with specialty pharmacy, though he added that about 85% of his patients obtain the drug for $60 or less through assistance and buy-down programs. The next place AJMC sends readers is the rest of its July 11, 2024 supplement, which includes a Q&A with Mile Brujic and additional interviews with Elizabeth Yeu, Neda Shamie and Eric Donnenfeld. (ajmc.com) A separate 2025 consensus paper from the Demodex Expert Panel on Treatment and Eyelid Health, or DEPTH, shows 15 ocular-surface specialists have since moved to formalize preferred treatment approaches through a Delphi process. (ajmc.com 1) (ajmc.com 2)