Chronic ocular irritation and frequent repeat visits may point to an underlying case of Demodex blepharitis.1 In this video, eyecare experts discuss the clinical and emotional burden of the disease and how misdiagnosis impacts practice efficiency. Learn how a simple shift in your slit-lamp routine – asking patients to look down – can reveal the disease hiding in plain sight. 2 Look for collarettes along the upper lash line to definitively identify Demodex blepharitis and bring clarity to complex cases.3
Transcript
0:05 – As a clinician, you’ve seen the pattern.
0:08 – A patient with chronic irritation.
0:10 – You move through the usual steps of warm compresses, lid scrubs, artificial tears.
0:16 – But patients keep coming back.
0:18 – You may not be getting to the root of the disease.
0:21 – Identifying Demodex blepharitis isn’t just about managing symptoms.
0:25 – It brings clinical clarity to complex cases and helps avoid diagnostic drift.
0:31 – When I see inflammation at the lid margin, particularly with collarettes, it tells me there’s more going on that ocular surface than just irritation or dryness.
0:41 – One of the most frequent complaints we hear is fluctuating vision.
0:46 – That’s often what prompts me to take a closer look.
0:49 – We also see similar challenges in contact lens wearers, and in patients with persistent dry eye symptoms.
0:55 – Demodex may be one of the contributors if someone is being evaluated for contact lenses or surgery.
1:02 – This gives me a reason to pause and reassess before we move forward.
1:07 – Even without a definitive treatment, having a name for what’s going on makes it easier to guide expectations and reduce frustration.
1:16 – Demodex blepharitis may be more common than expected in your preoperative evaluations.
1:22 – A European clinical panel reported signs of DB in 54% of patients when actively screened, highlighting the importance of examining the upper lid margin as a part of the complete ocular surface assessment.
1:35 – But for the patient, what begins at the lid margin becomes a daily struggle.
1:41 – Data from the Atlas study, a large multi-site survey of 311 patients living with DB, revealed that symptoms persisted for four years or more in half of patients and over six years in a third.
1:55 – The toll isn’t just clinical, it’s emotional, functional and physical.
2:02 – Nearly 8 out of 10 patients reported everyday impact.
2:05 – 47% say they’re conscious of their eyes all day.
2:10 – 47% struggle with driving at night.
2:14 – 34% of women reported difficulty wearing makeup, and 23% worry about the appearance of eyes or eyelids.
2:22 – And what begins as a personal burden soon becomes a practice burden.
2:28 – With all those patients who keep coming back to our office, the ones who’ve tried everything, but nothing works.
2:34 – Accurate diagnosis helps bring clarity to those cases, but we still need to develop better habits to truly address the root cause.
2:42 – This is a cycle of missed diagnosis.
2:45 – It’s the repeat visits that clogs our schedule.
2:48 – Effective diagnosis doesn’t require new tools or complex protocols.
2:53 – It starts with a change of habit, just adding one small step to your existing routine.
2:58 – At the slit lamp, ask the patient to look down.
3:01 – Examine the upper lash line at 10 to 16X magnification.
3:05 – Train your staff to identify collarettes during routine screening.
3:09 – Include an EMR prompt to record Demodex findings when present.
3:13 – This creates consistency and alignment across the clinical team and helps track the prevalence in your practice.
3:20 – We’ve standardized our approach to DB screening by incorporating margin checks into every anterior segment exam.
3:28 – It’s quick, it’s repeatable, and it ensures we’re not overlooking something that shows up more often than we used to think.
3:36 – That shift has made our evaluations more complete, but while diagnosis is now easier, what to do next remains the question.
3:44 – We still don’t have a definitive option that take all the root biology, so we’re left managing symptoms without truly resolving the condition.
3:53 – The burden is clear.
3:54 – It has a negative clinical impact, underdiagnosed or misdiagnosed.
3:58 – DB affects your patients’ lives and your practice efficiency.
4:03 – Identifying Demodex blepharitis is simple.
4:05 – Collarettes are the pathognomonic sign of DB.
4:08 – Ask your patients to look down. Screen for collarettes.
4:13 – Make it part of your routine.
4:23 – Scan the code to join the Collarettes Community and get the latest updates on Demodex blepharitis education.
