Demodex Blepharitis Diagnostic Consensus Achieved Among Eye Care Professionals

Demodex blepharitis diagnostic consensus has been achieved for identifying signs and symptoms associated with the condition, according to a Delphi method study published in Eye. However, consensus was not reached for determining the best treatments or grading disease severity.

Researchers distributed a total of 3 rounds of online surveys to 12 ocular surface disease experts (ophthalmologists, 9; optometrists, 3; mean age, 53.7 years; mean time in practice, 23.9 years) and presented a series of  scaled, open-ended, true or false, and multiple-choice questions. Intentionally repeated questions that were worded differently were included to evaluate the consistency of the panelists’ responses. The team used a 9-point Likert scale to determine Demodex blepharitis diagnostic consensus and agreement for treatment and severity grading. Median scores of 7 to 9 and 1 to 3, or agreement between 8 of the 12 panelists, determined consensus. 

Overall, the participants reached a Demodex blepharitis diagnostic consensus, agreeing that the condition is chronic (n=11), recurrent (n=12), and frequently misdiagnosed.  The panelists also agreed that collarettes were the most common sign of Demodex blepharitis (n=10) and that itching was the most common symptom (n=12). They also agreed that Demodex blepharitis may be diagnosed based on collarettes, mites, or patient symptoms (n=10) and that patients who are unresponsive to lid management therapies should be evaluated for Demodex blepharitis (n=12). 

While the panelists achieved a Demodex blepharitis diagnostic consensus, they failed to reach consensus in determining the most effective over-the-counter treatments for the condition or the best methods for severity grading. 

“Increased awareness of Demodex blepharitis in the eyecare community will raise the level of care received by patients with blepharitis and offer some a more targeted treatment strategy and better clinical outcomes,” according to the researchers.

Study limitations include a small panel size and potential survey bias.