Language
English
Publication Date
1-1-2025
Journal
Clinical Ophthalmology
DOI
10.2147/OPTH.S525681
PMID
40551956
PMCID
PMC12183565
PubMedCentral® Posted Date
6-18-2025
PubMedCentral® Full Text Version
Post-print
Abstract
Purpose: To reach consensus on Demodex blepharitis (DB) treatment approaches using a modified Delphi process involving 15 ocular surface disease experts.
Methods: The Demodex Expert Panel on Treatment and Eyelid Health (DEPTH) consisted of 15 well-published ocular surface disease experts. Panelists completed two online surveys, a live consensus meeting, and a follow-up survey. The surveys consisted of scaled and multiple-choice questions related to the clinical and patient-reported outcomes of DB and its treatment. For the scaled questions using a 1 to 9 Likert scale, consensus was defined as weighted mean scores of 1-3 and 7-9, whereas for multiple-choice questions, consensus was achieved when a minimum of 10 of 15 panelists agreed.
Results: The DEPTH panel reached consensus that lotilaner ophthalmic solution, 0.25% should be the first-line treatment for DB. Experts agreed no additional clinical findings are needed to prompt treatment with lotilaner ophthalmic solution, 0.25% for patients with >10 collarettes (12/15), while one additional clinical finding is needed for patients with 0-2 (11/15) or 3-10 collarettes (10/15). In the absence of allergies, panelists would consider first-line treatment for DB in a patient with eyelid itching but without collarettes (weighted mean: 7.47; range: 2-9). Panelists agreed that blepharoexfoliation (weighted mean: 8.27; range: 3-9) or intense pulsed light (IPL) therapy (weighted mean: 8.4; range: 6-9) could supplement first-line treatment with lotilaner ophthalmic solution, 0.25%. The DEPTH panelists agreed that topical (10/15) and systemic ivermectin (14/15) are not their preferred treatment for DB. Experts did not reach consensus about the use of tea tree oil to treat DB.
Conclusion: Experts achieved consensus on the use of lotilaner ophthalmic solution, 0.25% as the first-line treatment for patients with DB. Panelists also agreed that blepharoexfoliation or IPL therapy could serve supplementally to lotilaner ophthalmic solution, 0.25%, if needed.
Keywords
blepharitis, Demodex, treatment, Delphi
Published Open-Access
yes
Recommended Citation
Donnenfeld, Eric; Nichols, Kelly K; Ayres, Brandon D; et al., "The Demodex Expert Panel on Treatment and Eyelid Health (DEPTH) Consensus Regarding the Preferred Treatment for Demodex Blepharitis" (2025). Faculty and Staff Publications. 5466.
https://digitalcommons.library.tmc.edu/baylor_docs/5466