The Demodex Expert Panel on Treatment and Eyelid Health (DEPTH) Consensus Regarding the Preferred Treatment for...

To reach consensus on Demodex blepharitis (DB) treatment approaches using a modified Delphi process involving 15 ocular surface disease experts.

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.

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.

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.