Demodex Blepharitis

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  • Chronic blepharitis without improvement on standard treatment, collarettes (cylindrical dandruff at the root of eyelashes)


  • Eyelid hygiene with NaviBlef or TEBO Lip 1-2x/d for 2 weeks or longer if chronic, alternatively Blephademodex pads 1-2x/d for 4 weeks
  • alternatively Tea tree oil 5% (CAVE: severe burning, educate patients about this side effect!) or Metronidazole gel 0.75% or Metrogel 2% 2-3x/d
  • Systemic therapy in case of pronounced findings:
    • Flagyl (Metronidazol) as short-term therapy: 1x 2g p.o. (=4 tbl. / 500mg) in the evening
    • alternatively Metronidazole 2x500mg/d for 10 days
      • CAVE: No alcohol ingestion, Antabuse side effect!
    • Alternative: Azithromycin 2x250mg/d for 3 days, then 7 days break, repeat therapy cycle 4 times
    • Alternative: Stromectol (Ivermectin) 2x6mg (= 2 tbl. / 3mg) on the 1st + 14th day of treatment
      • not available in Switzerland, must be imported from France
      • Contraindication: Pregnancy + lactation (teratogenic), children <5y or <15kg, therapy with inhibitors of P-glycoprotein


  • Slit lamp: collarettes visible? Highly correlated with Demodex blepharitis!
    • have patients close their eyes, examine the lash follicles on the upper lid
    • epilation of eyelashes not mandatory
  • Detection of Demodex under the microscope
    • epilate 2-4 eyelashes, placing them on a glass slide, put 1 drop of 0.9% NaCl and add fluorescein on top
    • cover with a cover slip, place under a microscope with a burning light for approx. 10-20min (heat activates Demodex, causing them to move)
    • examine them under the microscope (20-40x magnification) for the presence of mites in the area of collarettes


  • EyeWiki Demodex
  • – Collarettes Equal Demodex Blepharitis
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)