Demodex blepharitis is a condition that is commonly encountered
in eye care practices. A high prevalence of Demodex blepharitis, ranging from
41% to 70%, has been reported worldwide. Despite the high prevalence of Demodex
blepharitis, patients with the condition may go undiagnosed or misdiagnosed for
years. Even when Demodex blepharitis is diagnosed, inconsistent and typically
suboptimal efficacy with over-the-counter and other management options and the
absence of an FDA-approved prescription therapeutic disincentivizes treatment.
When the underlying cause goes untreated, the immune-mediated inflammatory
processes associated with chronic Demodex blepharitis are detrimental to the
eyelid and ocular surface health, presenting as itchy, irritated, and dry eyes,
fluctuating and blurred vision, lid and lash abnormalities, ocular surface
inflammation, noticeable eye and eyelid erythema, and contact lens intolerance
and reduced wear time
O’Dell et al hypothesized that the persistent burden of
blepharitis symptoms may also worsen and negatively affect patients’ quality of
life and may have an impact on health care system resource utilization. In this
multicenter, observational, prospective, IRB-approved study, 311 Demodex
blepharitis patients aged ≥18 years were included. Demodex blepharitis was
diagnosed based on the presence of ≥1.0 mite per lash (upper and lower eyelids
combined), >10 collarettes on the upper lashes, and at least mild lid margin
erythema of the upper eyelid in at least one eye. All patients were asked to
complete a questionnaire about their symptoms, daily activities, quality of
life, and management approaches, and descriptive statistics were used to
analyze the responses.
More than half the patients had been experiencing symptoms
of blepharitis for ≥4 years. The three most frequent and bothersome symptoms
experienced by patients were dry eyes, itchiness, and irritation.
Nearly half the patients (47%) responded that they were
conscious of their eyes all day, and 23% said that they were constantly
worrying about their eyes.
Other activities that were negatively affected included
difficulty driving at night (47%), additional time needed for daily hygiene
routine (30%), and difficulty in wearing eye make-up (in 34% of females).
While all subjects had objective signs of Demodex
blepharitis confirmed by an eye care provider, 58% said they had never
previously been diagnosed with blepharitis.
The most commonly used management approaches for Demodex
blepharitis were artificial tears (47%), warm compresses (32%), and lid wipes
(14%).
Demodex blepharitis is a highly prevalent lid margin
disease; still, it is often overlooked or misdiagnosed and, as a result,
patients may struggle with the condition for years. Patients with a confirmed
diagnosis of Demodex blepharitis were asked questions about ocular symptoms,
prior diagnoses, success with over-the-counter and other management options,
comorbidities, and daily activities. The analysis of the questionnaire responses
shows that Demodex blepharitis is associated with considerable symptomatic and
psychosocial burden, negatively affecting daily life in the vast majority of
patients with the disease.
The symptoms of Demodex blepharitis seem to impair daily
activities and to be long-lasting. As with other lid margin and ocular surface
diseases, dryness was the most common symptom reported and one of the most
bothersome, as well.
Itch has been identified by other authors as a symptom
characteristic of Demodex blepharitis. Ocular irritation, awareness of the eyes
and foreign body sensation were also common.
Frequent and bothersome symptoms may affect visual
concentration, disrupting productivity and affecting visually demanding tasks
such as night driving. Nearly half the patients in the present study reported
difficulty driving at night. Degradation of optical quality related to DED has
previously been associated with visual impairments during driving; as such,
blurred vision (reported by 27% of patients in the present study) may also have
contributed to difficulties in night driving.
Untreated chronic disease may have substantial financial
implications for affected patients and for the health care system, particularly
because many patients experience blepharitis symptoms over long periods of time
The present study also explored the psychosocial impact and
appearance-related concerns of patients with Demodex blepharitis. Overall,
Demodex blepharitis negatively impacted 80% of patients on psychosocial
metrics, including contributing to a negative appearance to others, causing
worry and even an altered mental state. Pro-inflammatory cytokines reportedly
cross the blood-brain barrier and can induce psychosocial and behavioral
changes.
This study is limited by its observational nature and the
fact that it relies on patient recollection of symptoms, attempted therapies,
doctor visits, and prior diagnoses. However, it confirms that patients with
Demodex blepharitis frequently experience and are bothered by ocular symptoms.
These patients allocate time and resources to health care appointments and
approaches that often do not resolve their symptoms, contributing to individual
and health care system costs. Additionally, patients with Demodex blepharitis
perceive significant negative effects on their daily activities, mental and
physical well-being. Treatments that safely and effectively treat Demodex
blepharitis and are simple to use are needed to relieve the symptom burden and
reduce psychosocial effects of Demodex blepharitis.
Source: O’Dell et al; Clinical Ophthalmology 2022:16
https://doi.org/10.2147/OPTH.S374530