Topical Ivermectin Yields Favorable Outcomes in Patients With Demodex Blepharitis

Blepharitis or inflammation of the eyelid
Blepharitis. View of an inflamed upper eyelid with scaly skin at the lid margins. This condition is known as blepharitis. The patient may complain of a burning sensation in the eye and occasionally the eyes themselves may become inflamed. In some cases the eyelashes become infected, and small ulcers form. Blepharitis is common, tends to recur, & may be associated with eczema or dandruff. The problem can often be cleared up by removing the scales with cotton-wool moistened with warm water. Various eye-drops can reduce discomfort, but cannot prevent recurrences.
Appropriate eyelid hygiene should be used in conjunction with topical ivermectin treatments.

Ivermectin 1% cream demonstrates efficacy in treating ocular symptoms associated with Demodex blepharitis when used 15 minutes, once per week, according to a study published in Cornea.

Investigators divided 102 eyes with Demodex blepharitis into an experimental and control group, as determined by the use of topical ivermectin, in this retrospective case-control study. They subjectively evaluated dryness via the Standard Patient Evaluation of Eye Dryness (SPEED) symptom questionnaire, and analyzed Oxford staining score, eyelid debris, eyelid redness/swelling, and telangiectasia during follow-up visits. Both groups performed lid hygiene daily using a product containing tea tree oil.

The SPEED score and eyelid debris grade significantly improved in both groups at follow-up, with more significant improvements noted in the ivermectin group compared with controls (7.4±5.0, P <.001 and 8.0±5.1, P =.009, respectively). The Oxford staining score, eyelid redness/swelling grade, and telangiectasia grade, however, only showed significant improvement in participants using ivermectin (P =.005, P <.001, and P =.006, respectively).

“Based on these results, it is believed that a combination of topical ivermectin 1% cream and eyelid hygiene can be prescribed as an effective treatment for Demodex blepharitis,” according to the researchers.

The study is limited by a small sample size, reliance on patient self-reporting to document eyelid hygiene and topical treatments, and failure to confirm the absence of Demodex via biomicroscopy. 


Choi Y, Eom Y, Yoon EG, Song JS, Kim I-H, Kim HM. Efficacy of topical ivermectin 1% in the treatment of Demodex blepharitis. Cornea. 2022;41(4):427-434. doi:10.1097/ICO.0000000000002802.