Let's Talk Demodex | Look at the Lids

Tiny mites are causing big problems

Demodex blepharitis is caused by an infestation of Demodex mites, the most common ectoparasite found on humans.1

Common clinical consequences of Demodex blepharitis may include1

  • Dry eye
  • Red, itchy, or irritated eyelids
  • Missing or misdirected eyelashes
  • Inflammation of the conjunctiva and eyelid margin
  • Recurrent chalazia
Video by Eric Rosenberg, DO
Video by Eric Rosenberg, DO

80% of patients surveyed said Demodex blepharitis has a negative impact on their daily activities.2

Real-world daily activities impact2

  • Difficulty driving at night: 47%
  • Additional time needed for daily hygiene routine: 30%
  • Difficulty wearing makeup (women only): 34% (n=63/185)
  • Negative appearance of eyes/eyelids: 23%
  • Feeling conscious of eyes all day: 47%
  • Constant worrying about eyes or eyelids: 23%

Many patients have objective signs of Demodex blepharitis, including collarettes, Demodex mites, and lid margin redness.1

Real-world data from a prospective, multicenter, observational study of 311 patients to evaluate the impact of DB.

81% of patients with Demodex blepharitis who were surveyed sought some form of treatment2

Harmless mites? Think again

DB can cause damage in 3 main ways

Mechanical: microscopic epithelial abrasions from Demodex claws can lead to ocular surface irritation, keratitis, and eyelash distention/loss3-5
Chemical: production of cytokines, chemokines, and other inflammatory biomarkers may alter meibum composition and cause ocular surface and lid margin inflammation1,6
Bacterial: transportation of bacteria on the mite’s surface and in the gut, which may trigger an immune response in the eyelid1,6-8

DB is written all over their eyelids

Collarettes are the pathognomonic sign of Demodex blepharitis1

100% of patients with collarettes are found to have Demodex mites. If they have collarettes, then they must have Demodex.3

Collarettes are cylindrical, waxy debris of mite waste products and eggs found at the base of the eyelashes and can be identified during a routine slit lamp exam.1,6

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1. Fromstein SR, Harthan JS, Patel J, Opitz DL. Demodex blepharitis: clinical perspectives. Clin Optom (Auckl). 2018;10:57-63. 2. O’Dell L, Dierker DS, Devries DK, et al. Psychosocial impact of Demodex blepharitis. Clin Ophthalmol. 2022;16:2979-2987. 3. Gao YY, Di Pascuale MA, Li W, et al. High prevalence of Demodex in eyelashes with cylindrical dandruff. Invest Ophthalmol Vis Sci. 2005;46(9):3089-3094. 4. 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. 5. English FP, Nutting WB. Demodicosis of ophthalmic concern. Am J Ophthalmol. 1981;91(3):362-372. 6. Bitton E, Aumond S. Demodex and eye disease: a review. Clin Exp Optom. 2020;104(3):285-294. 7. Li J, O’Reilly N, Sheha H, et al. Correlation between ocular Demodex infestation and serum immunoreactivity to Bacillus proteins in patients with facial rosacea. Ophthalmology. 2010;117(5):870-877. 8. Zhu M, Cheng C, Yi H, Lin L, Wu K. Quantitative analysis of the bacteria in blepharitis with Demodex infestation. Front Microbiol. 2018;9:1719.