Consensus guidance helps identify misdiagnosed demodex blepharitis

Two case reports suggest that applying consensus recommendations from the Demodex Expert Panel on Treatment and Eyelid Health (DEPTH) may help identify demodex blepharitis (DB) after an initial misdiagnosis.

The case series described a 75-year-old woman who initially received unsuccessful treatment for a presumed bacterial infection despite presenting with collarettes, reduced meibomian gland secretions, and lid margin erythema. After being diagnosed with DB, she was treated with lotilaner ophthalmic solution 0.25% twice daily for 6 weeks. Clinical findings and patient-reported outcomes improved after treatment.

A second case involved a 62-year-old man whose ocular discomfort, dry eye, burning, and itching were initially treated as dry eye disease without success. Detection of collarettes prompted a diagnosis of DB, and treatment with lotilaner ophthalmic solution 0.25% reduced collarettes and resolved his reported symptoms.

The authors said the cases demonstrate how the DEPTH consensus findings may improve recognition and diagnosis of DB and support appropriate treatment in patients who were initially misdiagnosed.

Reference

Periman LM, Lindstrom R, Karpecki P, et al. Using Lotilaner Ophthalmic Solution, 0.25% to Treat Demodex Blepharitis in Patients Who Were Initially Misdiagnosed: A Case Series. Clin Optom (Auckl). 2026;18:600893. doi: 10.2147/OPTO.S600893. PMID: 42371506; PMCID: PMC13310504.