Blepharoexfoliation procedures done in-office have shown to be effective in reducing Demodex blepharitis in this prospective study.
Blepharoexfoliation procedures done in-office have shown to be effective in reducing Demodex blepharitis in this prospective study. Photo: Katherine Sanford, OD. Click image to enlarge.

Manual lid margin exfoliation is often used in conjunction with topical therapeutics in cases of severe blepharitis, but experts say that the combination treatment’s efficacy may be influenced by factors such as the quality of instruction given, patients’ compliance to therapy and severity of blepharitis. According to the authors of a recent study on blepharoexfoliation in Demodex blepharitis, devices for mechanical removal of eyelid debris may help improve outcomes.

Their prospective, comparative, interventional study evaluated the safety and efficacy of the commercially available blepharoexfoliation device BlephEx. A total of 81 patients with microscopically confirmed Demodex blepharitis were included. The treatment group received in-office blepharoexfoliation with tea tree oil 2% shampoo, followed by eyelid scrubs with tea tree oil 2% shampoo twice a day for eight weeks. The control group received the same treatment but with a sham blepharoexfoliation procedure.

The mean baseline OSDI score was 33.3 and Demodex count was 4.84. The researchers noted that the baseline Demodex count was moderately correlated with the baseline OSDI score and baseline MGD severity. At eight weeks, mean OSDI scores were 22.62 and 27.09 in the blepharoexfoliation and control groups, respectively. Mean Demodex counts were 2.60 and 3.03, respectively. The authors reported improvement in MGD in both groups. The blepharoexfoliation group demonstrated a moderate correlation between the change in OSDI score and baseline OSDI score.

“A session of in-office blepharoexfoliation added to daily scrubs was more successful in reducing the Demodex count and improving symptoms compared with daily manual scrubs alone,” the researchers wrote in their paper. They noted that studies in which epilation was performed immediately after treatment may help to support their findings.

Mohammad-Rabei H, Arabi A, Shahraki T, et al. Role of blepharoexfoliation in Demodex blepharitis: a randomized comparative study. Cornea. April 14, 2022. [Epub ahead of print].