At CIME 2025, Neda Shamie, MD, answers questions about Demodex blepharitis

At the Controversies in Modern Eye Care meeting, Neda Shamie, MD, brought renewed attention to an often underdiagnosed and undertreated condition: Demodex blepharitis. She emphasized its widespread prevalence across both ophthalmology and optometry practices and highlighted the critical need for greater clinical vigilance.

“Demodex blepharitis is highly prevalent in our patient populations, yet it’s commonly overlooked,” Shamie stated. In her surgical practice, she finds that over 60% of cataract surgery candidates present with signs of Demodex infestation—often undiagnosed until a thorough preoperative evaluation. These findings are not limited to the elderly; younger patients, particularly contact lens wearers, are also frequently affected.

A key challenge is that Demodex blepharitis mimics other ocular conditions, leading to frequent misdiagnoses. “Patients come in with a diagnosis of allergies or dry eye, but when they don’t respond to conventional therapies, we have to ask ourselves—could it be Demodex?” she said. Failure to correctly identify Demodex involvement can prolong symptoms and impair visual rehabilitation, particularly in surgical candidates.

Shamie outlined a straightforward and effective clinical approach to diagnosis. “You don’t need to pluck lashes or use a microscope,” she explained. “All it takes is a slit lamp exam with the patient looking down. If you see cylindrical collarettes at the base of the lashes—that’s pathognomonic for Demodex.” Additional signs include misdirected or atrophic lashes, lid margin erythema, and conjunctival hyperemia. These clinical features should prompt a high index of suspicion, particularly in patients unresponsive to anti-allergy or dry eye treatments.

She underscored the importance of educating both patients and practitioners about Demodex, noting that proactive detection and targeted management can significantly improve ocular surface health, patient comfort, and outcomes in both routine and surgical settings.

As Demodex blepharitis becomes increasingly recognized for its role in chronic ocular surface disease, Shamie’s message is clear: “If your patient isn’t responding as expected, take a closer look at the lashes. The collarettes will tell you everything you need to know.”