Demodex blepharitis (DB): common, but overlooked

Video by Eric Rosenberg, DO
Video by Eric Rosenberg, DO
of eye care patients in the United States have DB1,*

DB is an eyelid margin disease brought on by an infestation of Demodex mites and characterized by collarettes, a waxy buildup of debris around the base of the eyelid.1,2

DB is a common condition — chances are, you may have already seen patients with it.1,3

of eye care patients in the United States have DB1,*

DB is an eyelid margin disease brought on by an infestation of Demodex mites and characterized by collarettes, a waxy buildup of debris around the base of the eyelid.1,2

DB is a common condition — chances are, you may have already seen patients with it.1,3

DB doesn't discriminate

Signs can be found across patient groups1,*

Despite its prevalence, DB is frequently underdiagnosed due to symptom overlap with other ocular diseases. Collarettes are the pathognomonic sign you should look for.1-3

Meet the Demodex mite

Demodex mites are the most common ectoparasite found on human skin, usually concentrated around the nose, cheeks, and eyelids.2,4

Their digestive enzymes and waste products contribute to eyelid margin inflammation and the formation of collarettes.2,5

Percentage of blepharitis cases associated with Demodex mites1,*
*STUDY DESIGN: A retrospective chart review for DB by 7 investigators at 6 eye care clinics of the case records of patients (N=1032) who underwent a slit lamp examination, regardless of chief complaint.

Take a closer look

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Small mites, big damage

Demodex mites can cause damage and inflammation in 3 main ways:

Inflammation and DB:

A vicious cycle

Inflammation caused by Demodex mites creates ideal conditions for proliferation, leading to increasing mite density and worsening disease.1,2,7

Inflammation: a central driver of disease1,2,7,8

Inflammation can affect structures throughout the eye and is associated with many ocular complications.

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1. Trattler W, Karpecki P, Rapoport Y, et al. The prevalence of Demodex blepharitis in US eye care clinic patients as determined by collarettes: a pathognomonic sign. Clin Ophthalmol. 2022;16:1153-1164. 2. Fromstein SR, Harthan JS, Patel J, Opitz DL. Demodex blepharitis: clinical perspectives. Clin Optom (Auckl). 2018;10:57-63. 
3. O’Dell L, Dierker DS, Devries DK, et al. Psychosocial impact of Demodex blepharitis. Clin Ophthalmol. 2022;16:2979-2987. 4. Rhee MK, Yeu E, Barnett M, et al. Demodex blepharitis: a comprehensive review of the disease, current management, and emerging therapies. Eye Contact Lens. 2023;49(8):311-318. 5. Bitton E, Aumond S. Demodex and eye disease: a review. Clin Exp Optom. 2021;104(3):285-294. 6. Luo X, Li J, Chen C, Tseng S, Liang L. Ocular demodicosis as a potential cause of ocular surface inflammation. Cornea. 2017;36(Suppl 1):S9-S14. 7. Yeu E, Garg S, Ayres BD, et al. Current state and future perspectives in the diagnosis of eyelid margin disease: clinical review. J Cataract Refract Surg. 2024;50(8):868-875. 8. Xu H, Rao NA. Grand challenges in ocular inflammatory diseases. Front Ophthalmol (Lausanne). 2022;2:756689.