When your vision is blurry, go to your eye doctor. Wash your hands before putting your contacts in. That’s pretty much all there is to know about eye health, right? Think again.
As with any other part of your body, your eyes can get sick or infected—and while that’s not pleasant to think about, it’s important to consider what your eyes are up against so you know how to protect them and what your treatment options might be.
One of the most common (and rarely discussed) eyelid diseases is Demodex blepharitis. To get more insights on the disease, we spoke with Neda Shamie, M.D., an ophthalmologist and a cataract, LASIK, and corneal surgeon based in Los Angeles.
Prevention: What is Demodex blepharitis and what causes it?
Dr. Shamie: Demodex blepharitis is a common—yet often misdiagnosed—eyelid disease that is caused by an infestation of Demodex mites, the most common species of ectoparasite (parasites that attach themselves to human skin). These microscopic mites can exist on anyone’s body in low volumes and are not typically a cause for concern. However, when Demodex mites overpopulate in and around the eyelids, it can lead to a condition called Demodex blepharitis.
Prevention: How can you tell if you have Demodex blepharitis?
Dr. Shamie: The common signs of Demodex blepharitis that we look for are redness or inflammation around the eyes, missing or misdirected eyelashes, and the presence of collarettes.
Prevention: What are collarettes?
Dr. Shamie: Collarettes are cylindrical, waxy, crusty debris of mite waste and eggs found at the base of the eyelashes. Collarettes on the eyelids are the telltale sign of Demodex blepharitis: 100% of patients with collarettes have Demodex blepharitis.
Collarettes are the telltale sign of Demodex blepharitis. Note the waxy cylindrical debris at the base of the lashes and the misdirected and abnormal eyelashes.
Prevention: Is there anything you can do to prevent a Demodex mite infestation?
Dr. Shamie: I always stress the importance of maintaining healthy eye habits—obtaining regular eye exams, eating a healthy diet, removing eye makeup every night, and wearing UV protective eyewear in the sunlight—but it is not possible to prevent Demodex blepharitis as the mites can infiltrate the eyelid for no apparent reason. It is extremely common, and can impact all genders, ethnicities, and ages.
Prevention: Can someone tell if they have Demodex blepharitis without consulting an eye doctor?
Dr. Shamie: No, only an eye care provider can properly diagnose Demodex blepharitis. Consistent eye exams should be a part of everyone’s proactive healthcare journey, but in between regular checkups, a patient should consult an eye care provider if they experience any type of ocular discomfort or feel that something is not “right” with the way their eyes look or feel.
Prevention: How prevalent is Demodex blepharitis? Can anyone get it?
Dr. Shamie: Demodex blepharitis impacts approximately 25 million eye care patients in the U.S. That’s one out of every 12 adults. While research has shown that patients with other eye conditions—such as dry eye, cataracts, and glaucoma—exhibit Demodex blepharitis, the disease can impact patients across ages and all levels of eye health. Many people don’t know that they’re living with this disease, though, because other eye diseases share similar symptoms.
Demodex mites can exist on everyone’s skin; it’s only when these mites overpopulate that they can become an issue. If I see Demodex blepharitis during an eye exam, the first thing I do is inform patients that the disease is quite common and we can get it under control. These mites live on everyone, and they are merely dealing with an overgrowth of something that’s very natural. And the last thing they want to do is leave a disease that can be a cause of long-term problems untreated.
Prevention: What are the consequences of leaving Demodex blepharitis undiagnosed or untreated?
Dr. Shamie: Inflammation from Demodex blepharitis can cause a domino effect and can be a complicating factor in the management of overall eye health.
Prevention: So how can you treat Demodex blepharitis?
Dr. Shamie: Until recently, the only management options for Demodex blepharitis were eyelid hygiene based, such as cleaners, warm compresses, and exfoliation procedures, none of which are FDA approved. Everyone responds differently to treatment, but patients often have to perform these tasks daily to potentially obtain relief from symptoms. And none of these eyelid hygiene related options treat the root cause of the disease, which is the mite itself.
In July of 2023, the FDA approved XDEMVY (lotilaner ophthalmic solution) 0.25%, which is the first and only FDA-approved prescription eye drop treatment to directly target Demodex mites, the root cause of Demodex blepharitis. This treatment requires one drop in each eye twice daily (approximately 12 hours apart) for six weeks.
The first step of treating Demodex blepharitis is getting diagnosed. To receive proper diagnosis and to figure out which treatment works for you, patients should always consult with an eye doctor and make sure they understand all possible side effects for any prescribed medications. In clinical trials, the most common side effect for XDEMVY was stinging and burning in 10% of patients, and, in rare cases (less than 2% of patients), chalazion/hordeolum and punctate keratitis. Your doctor will be able to advise on your risk of developing these side effects, and what to do if they occur.
See additional Important Safety Information and full Prescribing Information for XDEMVY below.
Indications and Usage
XDEMVY (lotilaner ophthalmic solution) 0.25% is indicated for the treatment of Demodex blepharitis.
Important Safety Information
Most common side effects: The most common side effect in clinical trials was stinging and burning in 10% of patients. Other side effects in less than 2% of patients were chalazion/hordeolum and punctate keratitis.
Handling the Container: Avoid allowing the tip of the dispensing container to contact the eye, surrounding structures, fingers, or any other surface in order to minimize contamination of the solution. Serious damage to the eye and subsequent loss of vision may result from using contaminated solutions.
When to Seek Physician Advice: Immediately seek a physician’s advice concerning the continued use of XDEMVY if you develop an intercurrent ocular condition (e.g., trauma or infection), have ocular surgery, or develop any ocular reactions, particularly conjunctivitis and eyelid reactions.
Use with Contact Lenses: XDEMVY contains potassium sorbate, which may discolor soft contact lenses. Contact lenses should be removed prior to instillation of XDEMVY and may be reinserted 15 minutes following its administration.
For additional information, please see full prescribing information available at: www.xdemvy.com.
