Delphi Panel Consensus Regarding Current Clinical Practice Management Options for Demodex blepharitis

Marjan Farid; Brandon D Ayres; Eric Donnenfeld; Ian Benjamin Gaddie; Preeya K Gupta; Edward Holland; Richard Lindstrom; Stephen C Pflugfelder; Paul M Karpecki; Kelly K Nichols; Christopher E Starr; Elizabeth Yeu

doi:10.2147/OPTH.S399989

Delphi Panel Consensus Regarding Current Clinical Practice Management Options for Demodex blepharitis

Clin Ophthalmol. 2023 Feb 27:17:667-679. doi: 10.2147/OPTH.S399989. eCollection 2023.

Authors

Affiliations

¹ Gavin Herbert Eye Institute, UC-Irvine, Irvine, CA, USA.
² Wills Eye Hospital, Philadelphia, PA, USA.
³ Ophthalmic Consultants of Long Island, Long Island, NY, USA.
⁴ Gaddie Eye Centers, Louisville, KY, USA.
⁵ Triangle Eye Consultants, Raleigh, NC and Tulane University, New Orleans, LA, USA.
⁶ University of Cincinnati, Cincinnati, OH, USA.
⁷ University of Minnesota, Minneapolis, MN, USA.
⁸ Baylor College of Medicine, Houston, TX, USA.
⁹ Kentucky Eye Institute, Lexington, KY, USA.
¹⁰ University of Alabama at Birmingham, School of Optometry, Birmingham, AL, USA.
¹¹ Weill Cornell Medicine, New York, NY, USA.
¹² Virginia Eye Consultants, Norfolk, VA, USA.

Abstract

Purpose: To obtain consensus on Demodex blepharitis (DB) treatment using a modified Delphi panel process.

Methods: Literature search identified gaps in knowledge surrounding treatment of DB. Twelve ocular surface disease experts comprised the Demodex Expert Panel on Treatment and Eyelid Health (DEPTH). They completed a live roundtable discussion in addition to 3 surveys consisting of scaled, open-ended, true/false, and multiple-choice questions pertaining to the treatment of DB. Consensus for scaled questions using a 1 to 9 Likert scale was predefined as median scores of 7-9 and 1-3. For other question types, consensus was achieved when 8 of 12 panelists agreed.

Results: The experts agreed that an effective therapeutic agent for treatment of DB would likely decrease the necessity of mechanical intervention, such as lid scrubs or blepharoexfoliation (Median = 8.5; Range 2-9). When treating DB, panelists believed that collarettes serve as a surrogate for mites, and that eliminating or reducing collarettes should be the main clinical goal of treatment (Median = 8; Range 7-9). The panelists would treat patients with at least 10 collarettes, regardless of other signs or symptoms and agreed that DB can be cured, but there is always the possibility for a reinfestation (n = 12). There was also consensus that collarettes, and therefore mites, are the primary treatment target and the way by which clinicians can monitor patient response to therapy (Median = 8; Range 7-9).

Conclusion: Expert panelists achieved consensus on key facets of DB treatment. Specifically, there was consensus that collarettes are pathognomonic for DB, that DB patients with >10 collarettes should be treated even in the absence of symptoms, and that treatment efficacy can be tracked by collarette resolution. By increasing awareness about DB, understanding the goals of and monitoring treatment efficacy, patients will receive better care and, ultimately, better clinical outcomes.

Keywords: collarettes; cylindrical dandruff; eyelid disease; ocular surface disease.