Diagnosis Guide – Spotting Demodex blepharitis in clinical practice

Transcript

0:05 – What if one of the most commonly missed diagnosis in eye care was also the easiest to detect?
0:11 – It’s just three seconds away at 10 to 16X magnification through a slit lamp.
0:17 – For many clinicians, diagnosing Demodex blepharitis still means plucking lashes and examining them under a microscope.
0:24 – That may work for clinical trials, but not when you’ve got 30 patients waiting and you’re already an hour behind.
0:30 – The process is uncomfortable for patients, time consuming for staff, and rarely fits into the daily clinical workflow.
0:37 – In my early years of practice, Demodex simply wasn’t on the radar.
0:42 – It wasn’t something we worked out to look for routinely and the diagnostic tools felt inpractical for the pace of a standard clinic.
0:50 – The emphasis was on other causes of the emerging disease, so unless a patient had very obvious signs, Demodex wasn’t even part of the differential.
1:00 – That mindset stuck with me longer than it should have… 
1:04 – But even today many clinicians miss Demodex blepharitis due to a few small but critical oversights.
1:10 – Not asking the patient to look down. Not examining the upper lid margin.
1:15 – Without a look down maneuver and the magnification properly adjusted, collarettes on the upper lid margin often go unnoticed.
1:23 – For me, the shift came when I started integrating upper lid margin examination into my routine slit lamp workflow.
1:30 – I had a patient with persistent ocular surface symptoms that didn’t improve despite standard management approaches.
1:37 – I happened to ask them to look down and that’s when I saw it: clear collarettes along the upper lash line.
1:44 – It was an A-HA! moment.
1:46 – Once I began looking intentionally, I started finding Demodex far more often than I expected.
1:52 – It made me realize that I had likely been missing the true etiology in a significant portion of my chronic blepharitis patients suddenly.
1:59 – Collarettes are cylindrical, waxy debris of mite waste products and eggs found at the base of the eyelashes and can be identified during a routine slit lamp exam.
2:11 – The presence of collarettes alone is a pathognomonic sign of Demodex blepharitis.
2:16 – The Demodex Expert Panel on Treatment and Eyelid Health, or DEPTH, has classified Demodex blepharitis as a chronic, recurrent condition that may be under diagnosed in routine eye care, and prevalence data backs it up.
2:30 – Regardless of the initial reason for their visit to an eye care clinic.
2:34 – In the US, 58% of patients show signs of Demodex infestation.
2:39 – In Japan, the number climbs to 66%.
2:42 – Across Europe, 54% of patients screened show signs of Demodex blepharitis.
2:48 – It’s common, but underdiagnosed.
2:52 – Demodex blepharitis often presents with symptoms that mimic dry eye, meibomian gland dysfunction, or ocular allergies.
2:58 – Itching, irritation, and discomfort are common but non-specific.
3:03 – That overlap can lead to misclassification and delayed care.
3:07 – That’s why visual confirmation matters.
3:09 – Finding collarettes, or waxy sleeves around the lash base, can help differentiate DB from other conditions.
3:16 – Recognizing these signs during a slit lamp exam leads to faster, more accurate identification.
3:21 – Slit lamp diagnosis is quick and easy.
3:24 – Incorporating a simple look down maneuver and examining the upper lid margin at 10-16x magnification has significantly improved.
3:33 – It’s now a standard part of my anterior segment exam.
3:37 – I found that I identified Demodex much earlier, especially in patients presenting with non-specific irritation or lid margin disease that mimics MGD or allergy.
3:47 – This has allowed me to better tailor my management strategies and set more realistic expectations with patients.
3:54 – It also reduced frustration for both the patient and the practice, because we are not cycling through ineffective treatments before identifying the root cause.
4:01 – Ask the patient to look down.
4:05 – Set magnification to 10 to 16x.
4:08 – Examine the upper lash line.
4:10 – In just three seconds, you can confirm what was once easy to miss.
4:14 – This approach takes seconds and fits easily into any eye exam.
4:23 – Demodex blepharitis is easy to miss but even easier to confirm.
4:28 – Make this your new routine.
4:30 – Ask every patient. Every time.
4:33 – Look down. Screen for collarettes.
4:36 – Make the diagnosis.