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CIME 2024: Holding Demodex blepharitis treatment options under a microscope


James A Katz, MD, details treatment options for Demodex blepharitis, from tea tree oil to XDEMVY.

According to James A Katz, MD, Demodex blepharitis remains under-diagnosed and under-treated. To combat these pesky mites, he details treatment options in his 2024 Controversies in Modern Eye Care presentation, "Under the microscope: Confronting Demodex blepharitis with advanced treatment," which he presented with Marc Bloomenstein, OD, FAAO, on May 4.

Video Transcript

Editor’s note - The following transcript has been lightly edited for clarity.

James A Katz, MD:

Hi I'm Dr Jim Katz. I practice ophthalmology in the Chicago area. Today I had the opportunity to speak on Demodex blepharitis with a colleague of mine, Marc Bloomenstein, and what I spoke about was the different therapies for Demodex blepharitis. And there are a lot of different treatments we've had over the years. The issue with Demodex blepharitis, is we've never had a good treatment, 1 that showed efficacy, 1 that showed safety or really any of them that were FDA approved. I went through treatments such as tea tree oil, and the effects of that, although there can be side effects of irritation. I went through oral medications, ivermectin, methazolamide, and those types of medications. We went through microblepharoexfoliation, treatments to the lid surface itself. All these types of things have been used in the past to allow us to try to treat the irritation of the lids that can be caused by Demodex blepharitis, the redness that could be caused by Demodex blepharitis. Now we have a treatment, the treatment's lotilaner 0.25%, the marketed name is XDEMVY, and this product was FDA approved in July of 2023, and now we have it available. It's used twice a day for 6 weeks, 6 weeks because a lifecycle of this micro organism or mite is approximately 2 to 3 weeks, and we want to get through 2 life cycles.

So the whole idea is to allow this medication to work well. We went through the FDA protocol and how it got approval for the medication through the Phase 3 trial and how it showed efficacy for the eradication of mites in the eyelashes and eyelids and as well how it treated the eyes for redness to reduce the redness in the eyes. So those types of things were done, as well as importantly the primary endpoint of reducing collarettes, or that sleeve on the upper lash that can cause all the irritation and inflammation of the eye and how much reduced those collarettes were after a full course of treatment. So now we have a way that's quite efficacious, shows safety, and most importantly is FDA approved to easily treat Demodex blepharitis. We need to understand how to diagnose this by looking at that upper lid and having the patient look down. It's very easy to spot on the eyelids when we have the patient's look down at the slit lamp. But when we forget to do that it's easy to miss this diagnosis because some patients don't have a lot of symptoms. Some come in with subtle itching of the eyelid margin, subtle redness. So it's our job to look at that upper lid by having the patient look down, diagnose the Demodex blepharitis, and now easily treat it for our patients and improve how they feel.

So the take home message for optometrists is we really under-diagnose and under-treat this condition of Demodex blepharitis. So it's our job to identify patients, number 1, by having them look down and identify and see that they have Demodex blepharitis, get a good history to hear what their symptoms are, and now easily treat it with XDEMVY, or lotilaner 0.25% for 6 weeks.

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