What Is Demodex Blepharitis?

In a roundtable discussion, a panel of experts–including an ophthalmic surgeon, ophthalmologist, optometrist (OD), payer, ophthalmic assistant, and patient–provides a breakdown on Demodex blepharitis, a prevalent ocular disease caused by an infestation of Demodex mites.

Dr. Marjan Farid: Okay. Welcome, everybody. Thank you so much for joining us. We’re here to talk about Demodex blepharitis, and as we all know, Demodex blepharitis, treatment, diagnosis, identifying patients, it really takes a group effort, a team effort. We’re joined by an all-star cast of people who really are integral to the management of patients with Demodex blepharitis. So, I would like to start out with some introductions. My name is Marjan Farid. I do cornea and cataract surgery at the Gavin Herbert Eye Institute at UC Irvine. We’re joined by Eric, Dr. Eric Donnenfeld, who is from Ophthalmic Consultants of Long Island Vision, Dr. Paul Karpecki from Kentucky Eye Institute, Dr. Jeffrey Dunn, Pharm D from Cooperative Benefits Group.

We have Derrick Sterling, COA from the KTND Ophthalmology Associates, and we will also be joined by a patient, Mr. Dermott Ryan. We’re very happy to be having a patient perspective when it comes to Demodex blepharitis. It really is a journey for the patients and there is a lot of morbidity that goes along with having this Demodex blepharitis. So, it’s really a unique perspective to hear from the patient and what they have to go through to get treatment. So, we’ll jump right in. We really want to start out with, “What is Demodex blepharitis? How is it diagnosed? What is it? Who is really impacted?” Maybe I’ll jump right to our infamous Dr. Eric Donnenfeld to get a little bit of background on Demodex blepharitis.

Dr. Eric Donnenfeld: Well, Marjan, what we all know is that Demodex is extraordinarily common. As a matter of fact, almost every patient has Demodex. It’s a very common mite. There are two different varieties. One lives in the lashes, that’s Demodex folliculorum, and then there’s Demodex brevis, which lives in the bulimia glands. What we know is that Demodex is very common and what we did not know until recently was a profound effect that Demodex blepharitis has on patient’s quality of life, lid margin disease, and ocular surface disease. Demodex, again, is a mite and it lives at the base of the lashes. Its excrement, its inflammatory process causes the presence of small collarettes, which are little elevations of material at the base of the lashes.

What’s nice about that, if you can say it’s nice about that, is that it’s absolutely half-pneumonic that when you see these collarettes, you 100% know that the patient is infected with Demodex. What we look for is not just one Demodex collarette, but what we see constantly now that we look for it is we see patients whose lids are just completely covered with these collarettes. These patients overwhelmingly will have itching and the itching will be in the lids. They’ll have crusting, they’ll have erythema, and they have chronic disease. Almost always they’ve been misdiagnosed.

Dr. Marjan Farid: Yeah, I completely agree. We used to think you have to pluck an eyelash and look at it under the microscope to see the mites, but we really recognize that you don’t need to do that. You don’t really need high fancy technology. If you have patients look down, you can really see these collarettes very visibly at the base of the lashes. The key is to have patients look down, and I’ve made it part of my regular routine when I examine patients as part of my general eye health exam is to make sure I have patients look down and look for collarettes at the base of the lashes and found that it’s really so much more common than I previously thought.

Most of us have a few collarettes, but many of us have a lot. I’m recognizing that those patients that we had seen with ocular surface symptoms, discomfort, pain, irritation, really if you have them look down, many of these patients have an overgrowth of these mites and increased collarettes. Paul, let me ask you, is there a specific demographic that see Demodex blepharitis in more or what is the patient population?

Dr. Paul Karpecki: That’s a very important question. I think over the years of managing this condition, I always felt like we had a little more with the elderly age. You saw a little slight increase. But as we started researching and looking at it more carefully, we start to recognize that there really isn’t any specific age category. There may be some that are more affected as in elderly patients, we have a little bit more. Maybe someone in their 70s has more than someone in their 40s, but it doesn’t exclude the fact that it can affect any age. Children, routinely, I’ve seen patients come in with multiple hordeolum or recurrent hordeolum only to find out that yeah, they had Demodex blepharitis, so they were seven or nine.

So, we are aware of it at every age category, and then of course it increases I think over time. There are other subgroups where I feel like I’m seeing more of it that just patients who suffer from rosacea dermatological or even ocular rosacea. It seems to be a little higher. But then if you look at some of the studies like the Titan study out there, it is almost an all-commerce type of disease. Meaning that whoever shows up, whether they’re for a regular eye exam for cataract eval, glaucoma patients, contact lenses or dry eye, there’s a large percentage of that population in any one of those categories that has Demodex blepharitis.

So, it has very little to do with socioeconomic that we’re aware of. There’s no issue or association there. It’s an equal opportunity mite. If you’re very affluent or you are not, it doesn’t matter. It’s present. So, it’s one of those conditions that I think there may be a predilection to age a little or to certain races, but it is fairly ubiquitous across the population.