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CIME 2024: Diagnostic tips and treatments for managing Demodex blepharitis


James A. Katz, MD, discussed evolving treatments for Demodex blepharitis, highlighting traditional methods like tea tree oil and microblepharoexfoliation as well as a newer FDA-approved therapy, and emphasizing the need to examine the upper eyelid carefully to diagnose the condition.

James A. Katz, MD, covered a range of treatment options for Demodex blepharitis during a joint presentation with Marc Bloomenstein, OD, FAAO. Their talk, titled "Under the Microscope: Confronting Demodex Blepharitis with Advanced Treatment," was part of the 18th Annual Controversies in Modern Eye Care conference, held in Los Angeles, California, on May 4, 2024.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

James A. Katz, MD:

Hi, I'm Dr. Jim Katz. I practice ophthalmology in the Chicago area. Today I had the opportunity to speak on Demodex blepharitis with a colleague of mine, Marc Bloomenstein, and what I spoke about was the different therapies for Demodex blepharitis.

There are a lot of different treatments we've had over the years. The issue with Demodex blepharitis is we've never had a good treatment: one that showed efficacy, one that showed safety or really any of them that were FDA approved. I went through treatments such as tea tree oil, and the effects of that, although there can be side effects of irritation. I went through oral medications, ivermectin, methazolamide, and those types of medications. We went through microblepharoexfoliation, treatments to the lid surface itself. All these types of things have been used in the past to allow us to try to treat the irritation of the lids that can be caused by Demodex blepharitis, the redness that could be caused by Demodex blepharitis.

Now we have a treatment, the treatment's lotilaner 0.25%, the marketed name is Xdemvy, and this product was FDA approved in July 2023, and now we have it available. It's used twice a day for 6 weeks, 6 weeks because a lifecycle of this microorganism or mite is approximately 2 to 3 weeks, and we want to get through 2 life cycles. The whole idea is to allow this medication to work well.

We went through the FDA protocol and how it got approval for the medication through the phase 3 trial and how it showed efficacy for the eradication of mites in the eyelashes and eyelids and as well how it treated the eyes for redness to reduce the redness in the eyes. So those types of things were done, as well as importantly the primary endpoint of reducing collarettes, or that sleeve on the upper lash that can cause all the irritation and inflammation of the eye and how much reduced those collarettes were after a full course of treatment. So now we have a way that's quite efficacious, shows safety, and most importantly is FDA approved to easily treat Demodex blepharitis.

We need to understand how to diagnose this by looking at that upper lid and having the patient look down. It's very easy to spot on the eyelids when we have the patients look down at the slit lamp. But when we forget to do that it's easy to miss this diagnosis because some patients don't have a lot of symptoms. Some come in with subtle itching of the eyelid margin, subtle redness. It's our job to look at that upper lid by having the patient look down, diagnose the Demodex blepharitis, and now easily treat it for our patients and improve how they feel.

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