Modern Technologies in Demodex Blepharitis Diagnosis and Therapy (Review)

Blepharitis associated with Demodex infestation is a widespread condition, its complications include eyelid margin deformities, corneal erosions, and ulcers. The review considers the epidemiological and pathogenetic aspects, along with new trends in Demodex blepharitis diagnosis and treatment, and represents the comparative characteristics of current diagnostic modalities, including traditional light microscopy, lateral eyelash retraction and rotation, as well as intravital imaging technologies, such as confocal microscopy and optical coherence tomography. Improving imaging techniques using machine learning was found to enable to improve early diagnosis availability and provide early initiation of etiotropic therapy. The review analyzes the preparations for conservative treatment of Demodex blepharitis,representing them with regard to the specificity of pharmacological effects and systemic safety, special attention being given to the problems of toxicity and shelf-life expectancy of drugs. Combination drugs and different laser exposure effects on Demodex mites and eyelid margin structures were stated to be prospective and understudied treatment approaches. We demonstrated the heterogeneity of approaches to efficacy assessment of diagnostic and therapeutic methods that makes actual the necessity of developing a standardized scale of Demodex blepharitis severity; the scale reflecting both clinical characteristics and instrumental findings. The authors concluded that the development of noninvasive imaging techniques and the shortest and safest therapeutic algorithms would enable to switch over to a whole new level of therapy efficacy for patients with Demodex blepharitis.