Opinion

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Interview with Laura M. Periman, MD: Managed Care Considerations in the Treatment of Demodex Blepharitis

The standard of care for Demodex blepharitis has improved substantially. The current approach involves both identifying and treating the condition effectively. Patients with Demodex blepharitis may show symptoms such as eyelid itching, redness, and meibomian gland dysfunction. Diagnosis involves observing the presence of collarettes around the lash base during a clinical examination; the presence of collarettes is pathognomonic for Demodex blepharitis.

The FDA’s rigorous approval process ensures the safety and efficacy of treatments like lotilaner 0.25% ophthalmic solution, which is specifically approved for Demodex blepharitis. In contrast, treatments like oral or topical ivermectin lack FDA approval and proven efficacy for this condition. Also, traditional treatments, such as tea tree oil and topical ivermectin, have limitations. Tea tree oil is effective against bacteria but not well tolerated at concentrations high enough to kill Demodex mites. Topical ivermectin is unsuitable for eyelid use due to irritation.

In the phase 3 FDA trial for lotilaner 0.25%, significant improvements were observed within 2 weeks. After 6 weeks of treatment, there were statistically significant improvements in lid margin redness, thickening, Demodex mite load, and collarette reduction, and treatment was well tolerated.

Prescribing lotilaner 0.25% often requires navigating prior authorization hurdles from third-party payers, which may delay treatment and relief of symptoms. Accurate diagnosis and appropriate treatment of Demodex blepharitis can reduce costs associated with multiple visits to medical providers and multiple ineffective treatments. Directly addressing the cause of Demodex blepharitis via lotilaner 0.25% may simplify prescription regimens, reduce polypharmacy, and reduce costs.

This summary was AI-generated and reviewed by an AJMC editor.

For other articles and videos in this AJMC® Perspectives publication, please visit “Updates in the Management of Demodex Blepharitis

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