OBJECTIVES: Demodex blepharitis (Db) is an under-diagnosed disease caused by an overgrowth of Demodex mites. Db results in a chronic inflammation of the eyelid margin and has no FDA-approved treatments. This study aimed to understand how the disease is diagnosed and the patient journey in Db.

METHODS: The study combined a cross-sectional survey of US-based optometrists and ophthalmologists (Eye Care Providers - ECPs) and a retrospective medical chart review of patients diagnosed with Db for at least 6 months. The study assessed patient-specific data including demographics, diagnosis and examination history, and Db management history.

RESULTS: A total of 192 qualifying charts of Db patients (average age of 56 years, range 18-85) were provided by 61 participating ECPs. Three phases were identified in the patient journey: 1) Patient presentation pre-diagnosis; 2) path to diagnosis; and 3) post-diagnosis. At presentation, the most common symptoms included redness (55%), itchy eyelids (46%), and eye inflammation (40%), leading patients to their initial visits. Despite symptoms, only 37% of patients were diagnosed at presentation. On the path to diagnosis, patients received an average of 3 tests and were diagnosed primarily via the evaluation of lid margins using a bright light and a magnification (72%) and the high-magnification slit lamp examination (69%). Over-the-counter warm eye compresses were initiated in 45% of patients. More aggressive management with in-office eyelid blepharoexfoliation and topical prescription antibiotics were also used pre-diagnosis in 14% and 12% of patients, respectively. After Db diagnosis, 96% of patients received a variety of management, including dry-eye disease prescriptions (20%), topical antibiotics (15%), and in-office eyelid blepharoexfoliation (23%). Despite attempts at disease management, patients continued to see their ECPs an average of 3.3 times post-diagnosis due to unresolved Db symptoms.

CONCLUSIONS: These findings highlight the challenges of Db misdiagnosis and the lack of resolution using current approaches to Db disease management.