Treatment With Topical Ivermectin 1% Once a Month to Control Demodex Blepharitis

Abstract

Purpose: The study aimed to assess the effectiveness of a monthly application of topical 1% ivermectin cream, for 3 months, to the eyelids and eyelids margin, accompanied by gentle squeezing of meibomian glands and microexfoliation to the base of eyelashes, in the management of Demodex blepharitis. Methods: Thirty-eight patients diagnosed with Demodex blepharitis based on the presence of sleeves at the base of the eyelashes, telangiectasias, and signs of local inflammation with at least 4 Demodex mites observed at the lash roots were enrolled. Treatment involved applying 1% ivermectin topical cream using an eyelash brush in circular motion, gradually moving toward the eyelid margin. The procedure was repeated several times over 10 min by applying more cream. Each patient was evaluated before each treatment and 1 month after completion of the 3-month period. Results: Significant improvements in symptoms and signs were observed, with the disappearance of cylindrical sleeves on the base of the eyelashes, telangiectasias, signs of inflammation, and a significant decrease in night itching. The Schirmer test showed no changes, while the tear breakup time test exhibited slight yet statistically significant enhancement. No adverse events were reported during the study. Conclusions: The results of this investigation establish that Demodex blepharitis can be effectively managed by the application of 1% ivermectin cream once a month over a three-month period. This treatment approach, in conjunction with the gentle squeezing of meibomian glands and eyelid margin microexfoliation to the base of the eyelashes, resulted in the disappearance of objective indicators, such as cylindrical sleeves and telangiectasia, along with a significant reduction in nocturnal itching.