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Crean CS, Yeu E, Maiti S, Neervannan S. Ocular and Systemic Pharmacokinetics of Lotilaner Ophthalmic Solution, 0.25%, Following a Single Dose or Repeated Doses in Dutch-Belted Rabbits. J Ocul Pharmacol Ther 2024. [PMID: 39150371 DOI: 10.1089/jop.2024.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024] Open
Abstract
Purpose: To evaluate the ocular and systemic pharmacokinetics of lotilaner ophthalmic solution, 0.25%, following bilateral topical ocular administration of single and repeated doses in rabbits. Methods: Dutch-belted rabbits (n = 34) were administered lotilaner ophthalmic solution, 0.25%, eye drops, either in a single bilateral dose (Group 1) or twice a day bilaterally for 7 days and once on Day 8 (Group 2). The pharmacokinetics and tissue distribution levels of lotilaner were assessed following the single dose in Group 1 and the last dose in Group 2. The drug levels were examined in various ocular tissues and whole blood. The maximal concentration of the drug (Cmax), time to maximal concentration, the terminal phase elimination half-life, the area under the concentration-time curve (AUC), and total clearance of the drug were determined. Results: In the eyelid margins, lotilaner exhibited the highest observed concentrations at 0.25 hour (h), presenting a mean Cmax of 14,600 ng/mL in Group 1 and 20,100 ng/mL in Group 2. The highest AUC was in the eyelid margin at 242,000 h×ng/mL in Group 1 and 535,000 h×ng/mL in Group 2. In the eyelid margin, the observed clearance rate (0.634 mL/h in single dose, 0.288 mL/h in repeat dose) was the slowest among all ocular tissues in both groups, with the longest half-life of 152 h (∼6.3 days) observed in the repeat dose group. Conclusions: Lotilaner ophthalmic solution, 0.25%, demonstrated rapid ocular tissue absorption into the eyelid margin tissue with a long half-life of almost a week. No adverse effects were observed following topical ocular administration in Dutch-belted rabbits.
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Affiliation(s)
| | | | - Sathi Maiti
- Periman Eye Institute, Seattle, Washington, USA
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2
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Yeu E, Garg S, Ayres BD, Beckman K, Chamberlain W, Lee B, Raju L, Rao N, Rocha KM, Schallhorn J, Zavodni Z, Mah FS, Farid M. Current state and future perspectives in the diagnosis of eyelid margin disease: clinical review. J Cataract Refract Surg 2024; 50:868-875. [PMID: 38758201 DOI: 10.1097/j.jcrs.0000000000001483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
The eyelid margin is vital to ocular surface integrity. Much peer-reviewed literature has been established in eyelid margin inflammation, better known as blepharitis. The purpose was to review and understand the impact of eyelid margin disease. Anterior blepharitis causes inflammation at the eyelash base, ciliary follicles, and the palpebral skin. Posterior blepharitis occurs when there is inflammation with the posterior eyelid margin disease. In common usage, the term "blepharitis" used alone almost always refers to anterior blepharitis. Classification of eyelid margin disease should be based on etiopathogenesis, location, primary vs secondary, and chronicity. Blepharitis has several etiopathologies (infectious, inflammatory, and squamous). Meibomian gland dysfunction (MGD) can refer to the functional and/or structural problems with the meibomian gland. Meibomitis (or meibomianitis) occurs when there is inflammation associated with the MGD. The presence of blepharitis and/or MGD (with or without inflammation) can affect the ocular surface and thereby affect anterior segment and cataract surgeries. This review article evaluates the differential diagnoses of eyelid margin disease, including various forms of blepharitis, MGD, and meibomitis.
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Affiliation(s)
- Elizabeth Yeu
- From the Virginia Eye Consultants, Norfolk, Virginia (Yeu); Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California (Garg, Farid); Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania (Ayres); Comprehensive EyeCare of Central Ohio, Westerville, Ohio (Beckman); Casey Eye Institute, Oregon Health & Science University, Portland, Oregon (Chamberlain); Eye Consultants of Atlanta and Georgia Eye Bank, Atlanta, Georgia (Lee); New York University, Langone, New York, New York (Raju); Ophthalmic Consultants of Boston and Tufts University School of Medicine, Boston, Massachusetts (Rao); Medical University of South Carolina, Storm Eye Institute, Charleston, South Carolina (Rocha, Zavodni); Department of Ophthalmology and Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California (Schallhorn); The Eye Institute of Utah, Salt Lake City, Utah (Zavodni); Scripps Clinic, La Jolla, California (Mah);
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Davey PG, Farid M, Karpecki P, Gaddie IB, Chan A, Mun J, Neervannan S, Yeu E. Lotilaner Ophthalmic Solution, 0.25%, for the Treatment of Demodex Blepharitis. Healthcare (Basel) 2024; 12:1487. [PMID: 39120190 PMCID: PMC11311291 DOI: 10.3390/healthcare12151487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
Demodex blepharitis, a chronic lid margin disease, is caused by an infestation of Demodex mites, the most common ectoparasites in human skin and eyelids. Lotilaner ophthalmic solution, 0.25% (Xdemvy, Tarsus Pharmaceuticals), is the first therapy approved to treat Demodex blepharitis. This narrative review characterizes lotilaner ophthalmic solution, 0.25%, and describes its efficacy, safety, and tolerability. The safety and efficacy of lotilaner ophthalmic solution, 0.25%, for treating Demodex blepharitis was evaluated in four phase 2 and two phase 3 trials. The data of 980 patients included in these phase 2 and 3 clinical trials revealed that the proportion of eyes with a clinically meaningful reduction to 10 or fewer collarettes (the cylindrical, waxy debris found at the base of the eyelashes) ranged from 81 to 93%. The mite eradication rate confirmed by a microscopy of epilated lashes ranged from 52 to 78%. No serious treatment-related adverse events were reported in any of these clinical studies. As high as 92% of the patients receiving lotilaner eyedrops in the phase 3 trials found it to be neutral to very comfortable. Given the positive safety and efficacy outcomes, the drug is likely to become the standard of care in the treatment of Demodex blepharitis.
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Affiliation(s)
| | - Marjan Farid
- Gavin Herbert Eye Institute, University of California-Irvine, Irvine, CA 92697, USA;
| | | | | | - Arthur Chan
- Tarsus Pharmaceuticals, Inc., Irvine, CA 92618, USA; (A.C.); (J.M.); (S.N.)
| | - James Mun
- Tarsus Pharmaceuticals, Inc., Irvine, CA 92618, USA; (A.C.); (J.M.); (S.N.)
| | - Sesha Neervannan
- Tarsus Pharmaceuticals, Inc., Irvine, CA 92618, USA; (A.C.); (J.M.); (S.N.)
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Prerna, Chadha J, Khullar L, Mudgil U, Harjai K. A comprehensive review on the pharmacological prospects of Terpinen-4-ol: From nature to medicine and beyond. Fitoterapia 2024; 176:106051. [PMID: 38838826 DOI: 10.1016/j.fitote.2024.106051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/01/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024]
Abstract
Owing to their extensive biological potential, essential oils (EOs) and their bioactive phytochemicals have gained attention from the scientific community. Within this domain, Terpinen-4-ol (T-4-ol), a bioactive monoterpene alcohol and the major constituent of tea tree oil (TTO), has made its way into translational research. Recent literature on T-4-ol strongly indicates its diverse pharmacological properties, including but not limited to antimicrobial, antivirulent, anti-oxidant, anti-inflammatory, anti-hypertensive, and anti-cancer effects. Hence, this review is the first to provide a comprehensive overview of the sources, bioavailability, safety, pharmaceutical delivery systems, and multifaceted biological properties of T-4-ol, emphasizing its medicinal potential for widescale application. The antibacterial and antifungal effectiveness of T-4-ol has been discussed, encompassing its role in combating a broad spectrum of bacterial and fungal pathogens. The review delves into the antivirulent prospects of T-4-ol, shedding light on its ability to attenuate virulence and mitigate bacterial pathogenesis. Scientific literature on the anti-oxidant and anti-inflammatory activity of T-4-ol highlighting its role in neutralizing reactive oxygen species and modulating inflammatory pathways has also been collated. Furthermore, the review elaborates on the cardioprotective and anti-hypertensive properties of T-4-ol and augments literature on its anti-cancer mechanism against various cancer cell lines. The review also provides in-depth knowledge of the pharmaceutical formulations of T-4-ol and recent knowledge about its application in clinical/field trials. The exploration of these diverse attributes positions T-4-ol as a promising candidate for further research and therapeutic repurposing in various biomedical applications.
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Affiliation(s)
- Prerna
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Jatin Chadha
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Lavanya Khullar
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Umang Mudgil
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Kusum Harjai
- Department of Microbiology, Panjab University, Chandigarh, India.
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Barnett M, Simmons B, Vollmer P, Patel A, Whitson WE, Berdy GJ, Karpecki P, Periman LM, Holdbrook M, Baba SN, Meyer J, Yeu E. The impact of Demodex blepharitis on patient symptoms and daily life. Optom Vis Sci 2024; 101:151-156. [PMID: 38546756 DOI: 10.1097/opx.0000000000002111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
SIGNIFICANCE Patients with Demodex blepharitis have a considerable symptomatic burden that negatively impacts their daily activities and well-being. Despite chronic manifestations of and problems associated with blepharitis that resulted in multiple visits to eye care providers, Demodex blepharitis remained underdiagnosed or misdiagnosed. PURPOSE This study aimed to evaluate the effect of Demodex blepharitis on patients' daily activities and well-being. METHODS This prospective, multicenter, observational study recruited 524 patients with Demodex blepharitis from 20 U.S. ophthalmology and optometry practices. Demodex blepharitis was diagnosed based on the presence of the following clinical manifestations in at least one eye: >10 collarettes on the upper lashes, at least mild lid margin erythema of the upper eyelid, and mite density of ≥1.0 mite/lash (upper and lower combined). Patients were asked to complete a questionnaire related to their symptoms, daily activities, and management approaches. RESULTS The proportion of patients who experienced blepharitis symptoms for ≥2 years was 67.8%, and for ≥4 years, it was 46.5%. The three most bothersome symptoms ranked were "itchy eyes," "dry eyes," and "foreign body sensation." Overall, 77.4% of patients reported that Demodex blepharitis negatively affected their daily life. One-third (32.3%) of patients had visited a doctor for blepharitis at least two times, including 19.6% who visited at least four times. Despite having clinical manifestations of Demodex blepharitis confirmed by an eye care provider, 58.7% had never been diagnosed with blepharitis. Commonly used management approaches were artificial tears, warm compresses, and lid wipes. Among those who discontinued their regimen, 45.9% had discontinued because of either tolerability issues or lack of effectiveness. Among contact lens wearers, 64.3% of the patients either were uncomfortable wearing contact lenses or experienced vision changes "sometimes" or "frequently." CONCLUSION Demodex blepharitis results in a significant negative impact on daily activities, creating a psychosocial and symptomatic burden on patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - John Meyer
- The Eye Care Institute, Louisville, Kentucky
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6
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Sadri E, Paauw JD, Ciolino JB, Nijm L, Simmons B, Meyer J, Gaddie IB, Berdy GJ, Holdbrook M, Baba SN, Jalalat P, Yeu E. Long-Term Outcomes of 6-Week Treatment of Lotilaner Ophthalmic Solution, 0.25%, for Demodex Blepharitis: A Noninterventional Extension Study. Cornea 2024:00003226-990000000-00481. [PMID: 38334465 DOI: 10.1097/ico.0000000000003484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE The aim of this study was to evaluate the long-term outcomes of lotilaner ophthalmic solution, 0.25%, in the treatment of Demodex blepharitis. METHODS This observational, extension study included patients with Demodex blepharitis (N = 239) who completed the Saturn-1 study and presented for the day 180 visit. All participants were assessed at days 180 and 365 after the initiation of 6-week treatment with the study drug or its vehicle. RESULTS The proportion of patients with 0 to 2 collarettes (grade 0) was significantly higher in the study group (N = 128 patients) than in the control group (N = 111 patients) (39.8% vs. 2.7% at day 180 and 23.5% vs. 2.9% at day 365; P < 0.0001). Similarly, the proportion of patients with ≤10 collarettes (collarette grade 0-1) in the study group was significantly higher than in the control group (70.3% vs. 18.0% at day 180 and 62.6% vs. 21.9% at day 365; P < 0.0001). In the study group, erythema continued to improve even after completion of the 6-week lotilaner treatment. No serious ocular adverse events were observed in the study group, and there was 1 treatment-related ocular adverse event in the study group, which was considered mild. CONCLUSIONS After 6-week treatment with lotilaner ophthalmic solution, 0.25%, for Demodex blepharitis, no long-term concerns were observed during 1 year of follow-up. A high proportion of patients with 0 to 2 collarettes (grade 0) or ≤10 collarettes (collarette grade of 0 or 1) was observed throughout 1 year of follow-up, indicating that the efficacy of lotilaner ophthalmic solution, 0.25%, against Demodex blepharitis may last well after completion of therapy.
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Affiliation(s)
| | | | | | - Lisa Nijm
- Warrenville Eye Care and LASIK Center, Warrenville, IL
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Sharma N, Martin E, Pearce EI, Hagan S. A Delphi approach to establishing consensus on best practice for the diagnosis and treatment of Demodex blepharitis. Cont Lens Anterior Eye 2024; 47:102080. [PMID: 37949731 DOI: 10.1016/j.clae.2023.102080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
Demodex blepharitis does not have agreed standardized guidelines. The aim of this study was to classify signs and symptoms and to develop appropriate management strategies for Demodex blepharitis from a consensus of expert advice. METHODS A total of 11 anterior segment experts (ophthalmologists, optometrists and a contact lens optician) working in the United Kingdom participated in a modified 2-round Delphi panel. A mixed-methods approach was adopted and a survey questionnaire for round 1 was formulated, constructed from information in the available literature. Based on panel responses from round 1, feedback was provided and a round 2 questionnaire was formulated. More than two-thirds majority (72%) was used for consensus building. RESULTS Based on the clinical presentation of signs and symptoms along with associated conditions and risk factors, a diagnostic algorithm was proposed for the clinical investigation of Demodex blepharitis. A treatment algorithm was also proposed with first-line and second-line treatment recommendations for Demodex blepharitis. CONCLUSION The recommendation from this study provides the first effort in formulating clinical diagnostic algorithm and management guidelines for Demodex blepharitis. The guidelines include appropriate magnification on the slit lamp, associated signs, symptoms, risk factors and suggested management options. These guidelines can be used in a routine eyecare setting to encourage eyecare practitioners in tailoring the investigation and management of Demodex blepharitis.
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Affiliation(s)
- Nikhil Sharma
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
| | - Eilidh Martin
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
| | - Edward Ian Pearce
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
| | - Suzanne Hagan
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
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Awan B, Elsaigh M, Tariq A, Badee M, Loomba A, Khedr Y, Abdelmaksoud A. A Systematic Review and Meta-Analysis of the Safety and Efficacy of 0.25% Lotilaner Ophthalmic Solution in the Treatment of Demodex Blepharitis. Cureus 2024; 16:e52664. [PMID: 38380217 PMCID: PMC10878406 DOI: 10.7759/cureus.52664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/22/2024] Open
Abstract
Demodex blepharitis is marked by an excessive presence of Demodex mites on the eyelids, particularly in the lash follicles. While these microscopic mites are a natural component of the skin microbiota, their overabundance can lead to ocular complications. Symptoms associated with Demodex blepharitis include eyelid itching, inflammation, and ocular irritation. Our objective is to investigate Lotilaner as a potential treatment for Demodex blepharitis, assessing both the safety and efficacy of the ophthalmic formula in managing this disease. We conducted research in Web of Science, PubMed, Cochrane Library, and Scopus up to November 2023. The quality of studies was evaluated using the Cochrane Risk of Bias tool, and it was employed to evaluate the quality of evidence. Our meta-analysis was executed using Review Manager 5.4. We evaluated the safety and efficacy of Lotilaner ophthalmic solution with a concentration of 0.25%. The following outcomes were assessed: clinically meaningful reduction in collarette, collarette cure, composite cure, drop comfort, erythema cure, mite density, and mite eradication. In the case of dichotomous data, we used the risk ratio (RR) with a 95% confidence interval (CI). In our analysis, all included studies, comprising a total of 891 participants, consistently reported clinically meaningful reductions in collarettes. The findings were statistically significant, with Lotilaner demonstrating a substantially higher reduction compared to the vehicle group (RR = 3.09, 95% CI [2.65-3.60]; P-value < 0.0001). Notably, results for Drop Comfort outcomes were nonsignificant, indicating no discernible differences compared to the group that used the vehicle (RR = 1.03, 95% CI [0.98-1.07]; P-value = 0.26). However, both mite density and mite eradication outcomes exhibited significant improvements with Lotilaner in comparison to the vehicle (RR = 2.58, 95% CI [2.25-2.95]; P-value < 0.0001) and (RR = 3.80, 95% CI [2.88-5.01]; P-value < 0.0001). The Lotilaner ophthalmic solution at 0.25% showed superior efficacy over the vehicle in reducing collarettes, achieving complete mite eradication within six weeks, and significantly decreasing erythema in Demodex blepharitis. It demonstrated safety with no reported side effects compared to the vehicle. Direct comparative studies with alternative treatments are recommended for a comprehensive assessment of efficacy and safety.
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Affiliation(s)
- Bakhtawar Awan
- Department of General and Emergency Surgery, Northwick Park Hospital, London, GBR
| | - Mohamed Elsaigh
- Department of General and Emergency Surgery, Northwick Park Hospital, London, GBR
| | - Areej Tariq
- Department of Opthalmology, Shaikh Zayed Hospital, Lahore, PAK
| | - Mohammed Badee
- Department of Ophthalmology, Perfect Vision Eye Hospital, Cairo, EGY
| | - Abhinav Loomba
- Department of Opthalmology, Hull University Teaching Hospitals NHS Trust, Hull, GBR
| | - Yahya Khedr
- Department of Opthalmology, Hull University Teaching Hospitals NHS Trust, Hull, GBR
| | - Ahmed Abdelmaksoud
- Department of Opthalmology, Hull University Teaching Hospitals NHS Trust, Cottingham, GBR
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Zhang L, Wang J, Gao Y. Eyelid cleaning: Methods, tools, and clinical applications. Indian J Ophthalmol 2023; 71:3607-3614. [PMID: 37991291 PMCID: PMC10788755 DOI: 10.4103/ijo.ijo_1457_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/25/2023] [Indexed: 11/23/2023] Open
Abstract
Nowadays, people give more importance and pay closer attention to the condition of their eyelids and lid margins. This increased recognition of eyelid hygiene is due to the growing awareness that improper eyelid cleaning might lead to various ocular surface diseases such as blepharitis and meibomian gland dysfunction. These ocular surface diseases can greatly affect people's quality of life. This article reviews the latest procedures for proper eyelid cleaning, including indications, methods, tools, detergents, and clinical applications, to maintain a healthy ocular surface and assist in the treatment of dry eye and blepharitis.
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Affiliation(s)
- Ling Zhang
- Department of Ophthalmology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian Province, China
| | - Jingru Wang
- Department of Ophthalmology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian Province, China
| | - Yingying Gao
- Department of Ophthalmology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian Province, China
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Ayres BD, Donnenfeld E, Farid M, Gaddie IB, Gupta PK, Holland E, Karpecki PM, Lindstrom R, Nichols KK, Pflugfelder SC, Starr CE, Yeu E. Clinical diagnosis and management of Demodex blepharitis: the Demodex Expert Panel on Treatment and Eyelid Health (DEPTH). Eye (Lond) 2023; 37:3249-3255. [PMID: 36964261 PMCID: PMC10564779 DOI: 10.1038/s41433-023-02500-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 02/15/2023] [Accepted: 03/07/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Twelve ocular surface disease experts convened to achieve consensus about Demodex blepharitis (DB) using a modified Delphi panel process. METHODS Online surveys were administered using scaled, open-ended, true/false, and multiple-choice questions. Consensus for questions using a 1 to 9 Likert scale was predefined as median scores of 7-9 and 1-3. For other question types, consensus was achieved when 8 of 12 panellists agreed. Questions were randomized, and results of each survey informed the following survey. RESULTS Twelve practitioners comprised the Demodex Expert Panel on Treatment and Eyelid Health (DEPTH). Following 3 surveys, experts agreed that DB is chronic (n = 11) and recurrent (n = 12) and is often misdiagnosed. Consensus was achieved regarding inflammation driving symptoms (median = 7; range 7-9), collarettes as the most common sign (n = 10) and pathognomonic for DB (median = 9; range 8-9), and itching as the most common symptom (n = 12). Panellists agreed that DB may be diagnosed based on collarettes, mites, and/or patient symptoms (n = 10) and felt that patients unresponsive to typical therapies should be evaluated for DB (n = 12). Consensus about the most effective currently available OTC treatment was not reached. CONCLUSIONS The Delphi methodology proved effective in establishing consensus about DB, including signs, symptoms, and diagnosis. Consensus was not reached about the best treatment or how to grade severity. With increased awareness, eyecare practitioners can offer DB patients better clinical outcomes. A follow-up Delphi panel is planned to obtain further consensus surrounding DB treatment.
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Affiliation(s)
| | | | - Marjan Farid
- Gavin Herbert Eye Institute, UC-Irvine, Irvine, CA, USA
| | | | - Preeya K Gupta
- Triangle Eye Consultants, Raleigh, NC, USA
- Tulane University, New Orleans, LA, USA
| | | | | | | | - Kelly K Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
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Yeu E, Holdbrook M, Baba SN, Ceballos JC, Massaro-Corredor M, Corredor-Ortega C, Ramos-Betancourt N, Quiroz-Mercado H, Gonzalez-Salinas R. Treatment of Demodex Blepharitis: A Prospective, Randomized, Controlled, Double-Masked Clinical Trial Comparing Topical Lotilaner Ophthalmic Solution, 0.25% Eyedrops to Vehicle. Ocul Immunol Inflamm 2023; 31:1653-1661. [PMID: 35914297 DOI: 10.1080/09273948.2022.2093755] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/20/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of lotilaner ophthalmic solution, 0.25% eyedrops compared to vehicle for the treatment of Demodex blepharitis. METHODS In this randomized, controlled, double-masked clinical trial, 54 participants were randomly assigned in a 1:1 ratio to receive either lotilaner ophthalmic solution, 0.25% (study group) or the vehicle (control group) bilaterally, twice daily for 42 days. Outcome measures were collarette cure (collarette grade 0, upper eyelid), mite eradication (mite density of 0 mites/lash), and composite cure (grade 0 for collarettes and erythema). RESULTS The proportion of participants achieving collarette cure (80.0% vs 15.8%; p < .001), mite eradication (73.3% vs 21.1%, p = .003) and composite cure (73.3% vs 10.5%, p < .001) at Day 42 was statistically significantly higher in the study group than the control group. CONCLUSION Twice-daily 42-day treatment with novel lotilaner ophthalmic solution, 0.25% is safe and effective for the treatment of Demodex blepharitis compared to the vehicle control. (Registry number: ACTRN12620000320954, dated 09/03/2020).
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Affiliation(s)
| | | | | | - Juan Carlos Ceballos
- Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| | - Martha Massaro-Corredor
- Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| | - Claudia Corredor-Ortega
- Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| | | | - Hugo Quiroz-Mercado
- Research Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| | - Roberto Gonzalez-Salinas
- Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
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Gaddie IB, Donnenfeld ED, Karpecki P, Vollmer P, Berdy GJ, Peterson JD, Simmons B, Edell ARP, Whitson WE, Ciolino JB, Baba SN, Holdbrook M, Trevejo J, Meyer J, Yeu E. Lotilaner Ophthalmic Solution 0.25% for Demodex Blepharitis: Randomized, Vehicle-Controlled, Multicenter, Phase 3 Trial (Saturn-2). Ophthalmology 2023; 130:1015-1023. [PMID: 37285925 DOI: 10.1016/j.ophtha.2023.05.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/27/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of lotilaner ophthalmic solution 0.25% compared with vehicle for the treatment of Demodex blepharitis. DESIGN Prospective, randomized, double-masked, vehicle-controlled, multicenter, phase 3 clinical trial. PARTICIPANTS Four hundred twelve patients with Demodex blepharitis were assigned randomly in a 1:1 ratio to receive either lotilaner ophthalmic solution 0.25% (study group) or vehicle without lotilaner (control group). METHODS Patients with Demodex blepharitis treated at 21 United States clinical sites were assigned either to the study group (n = 203) to receive lotilaner ophthalmic solution 0.25% or to the control group (n = 209) to receive vehicle without lotilaner bilaterally twice daily for 6 weeks. Collarettes and erythema were graded for each eyelid at screening and at all visits after baseline. At screening and on days 15, 22, and 43, 4 or more eyelashes were epilated from each eye, and the number of Demodex mites present on the lashes was counted with a microscope. Mite density was calculated as the number of mites per lash. MAIN OUTCOME MEASURES Outcome measures included collarette cure (collarette grade 0), clinically meaningful collarette reduction to 10 collarettes or fewer (grade 0 or 1), mite eradication (0 mites/lash), erythema cure (grade 0), composite cure (grade 0 for collarettes as well as erythema), compliance with the drop regimen, drop comfort, and adverse events. RESULTS At day 43, the study group achieved a statistically significant (P < 0.0001) higher proportion of patients with collarette cure (56.0% vs. 12.5%), clinically meaningful collarette reduction to 10 collarettes or fewer (89.1% vs. 33.0%), mite eradication (51.8% vs. 14.6%), erythema cure (31.1% vs. 9.0%), and composite cure (19.2% vs. 4.0%) than the control group. High compliance with the drop regimen (mean ± standard deviation, 98.7 ± 5.3%) in the study group was observed, and 90.7% of patients found the drops to be neutral to very comfortable. CONCLUSIONS Twice-daily treatment with lotilaner ophthalmic solution 0.25% for 6 weeks generally was safe and well tolerated and met the primary end point and all secondary end points for the treatment of Demodex blepharitis compared with vehicle control. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Joseph B Ciolino
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | | | | | - José Trevejo
- Tarsus Pharmaceuticals, Inc., Irvine, California
| | - John Meyer
- The Eye Care Institute, Louisville, Kentucky
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Aghaei H, Torabi B, Abdolalizadeh P, Vaghfipanah H. Comparison of the effect of tea tree oil eye gel with standard treatment in patients with anterior blepharitis: An open-label clinical trial. Indian J Ophthalmol 2023; 71:2188-2192. [PMID: 37202946 PMCID: PMC10391484 DOI: 10.4103/ijo.ijo_2546_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose Daily cleansing of eyelids is very important to carry out a successful blepharitis treatment. However, there are no therapeutic guidelines for blepharitis. The aim was to compare the symptomatic relief of anterior blepharitis using Blephamed eye gel, a cosmetic product, versus standard treatment. Methods The study was a prospective, interventional open label clinical trial at a university-based hospital. The test population was subjects aged 18-65 years who presented with mild to moderate anterior blepharitis. Eyelid hygiene was applied twice a day. At each visit, a detailed assessment of symptomatology was carried out. A two-way repeated measure mixed model ANOVA was used to compare two groups by time. Results In total, 61 patients with mean age of 60.08 ± 16.69 years were enrolled in the study including 30 patients in standard group and 31 patients in Blephamed group. Two groups did not differ in terms of age (P = 0.31) and eye laterality (P = 0.50). The baseline scores of erythema, edema, debris, and symptoms as well as total score were similar between two groups (all P values >0.50). Two groups became different for all these parameters at day 45 (all P values <0.001). Significant interaction was detected between time and intervention groups for all severity parameters of blepharitis as well as total score (all P values <0.001). Conclusion Eyelid hygiene with Blephamed more significantly decreased symptoms of anterior blepharitis compared to standard treatment.
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Affiliation(s)
- Hossein Aghaei
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Behrouz Torabi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Parya Abdolalizadeh
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Homa Vaghfipanah
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Lotilaner Ophthalmic Solution, 0.25%, for the Treatment of Demodex Blepharitis: Results of a Prospective, Randomized, Vehicle-Controlled, Double-Masked, Pivotal Trial (Saturn-1). Cornea 2023; 42:435-443. [PMID: 35965392 PMCID: PMC9973441 DOI: 10.1097/ico.0000000000003097] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25%, compared with vehicle for the treatment of Demodex blepharitis. METHODS In this prospective, randomized, controlled, double-masked, phase 2b/3 clinical trial, 421 patients with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either lotilaner ophthalmic solution, 0.25% (study group), or vehicle without lotilaner (control group) bilaterally, twice daily for 43 days. Patients were evaluated at days 8, 15, 22, and 43. Outcome measures were complete collarette cure (collarette grade 0), clinically meaningful collarette cure (grade 0 or 1), mite eradication (0 mites/lash), erythema cure (grade 0), composite cure (grade 0 for collarettes/erythema), and drop comfort. Adverse events were also evaluated. RESULTS At day 43, the study group achieved a statistically significantly higher proportion of patients with clinically meaningful collarette cure (81.3% vs. 23.0%; P < 0.0001), complete collarette cure (44.0% vs. 7.4%; P < 0.0001), mite eradication (67.9% vs. 17.6%; P < 0.0001), erythema cure (19.1% vs. 6.9%; P = 0.0001), and composite cure (13.9% vs. 1.0%; P < 0.0001) than the control group. Nearly 92.0% of patients rated the study drop as neutral to very comfortable. All ocular adverse events in the study group were mild, with the most common being instillation site pain. CONCLUSIONS Twice-daily treatment with a novel lotilaner ophthalmic solution, 0.25% for 43 days, is safe and effective for the treatment of Demodex blepharitis compared with the vehicle control.
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O’Dell L, Dierker DS, Devries DK, Garlich J, Whitley WO, Holdbrook M, Baba SN, Yeu E. Psychosocial Impact of Demodex Blepharitis. Clin Ophthalmol 2022; 16:2979-2987. [PMID: 36081601 PMCID: PMC9447456 DOI: 10.2147/opth.s374530] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the impact of Demodex blepharitis on patients’ daily activities and quality of life. Patients and Methods In this multicenter, observational, prospective, IRB-approved study, 311 Demodex blepharitis patients aged ≥18 years were included. Demodex blepharitis was diagnosed based on the presence of ≥1.0 mite per lash (upper and lower eyelids combined), >10 collarettes on the upper lashes, and at least mild lid margin erythema of the upper eyelid in at least one eye. All patients were asked to complete a questionnaire about their symptoms, daily activities, quality of life, and management approaches, and descriptive statistics were used to analyze the responses. Results More than half the patients had been experiencing symptoms of blepharitis for ≥4 years. The three most frequent and bothersome symptoms experienced by patients were dry eyes, itchiness, and irritation. Nearly half the patients (47%) responded that they were conscious of their eyes all day, and 23% said that they were constantly worrying about their eyes. Other activities that were negatively affected included difficulty driving at night (47%), additional time needed for daily hygiene routine (30%), and difficulty in wearing eye make-up (in 34% of females). While all subjects had objective signs of Demodex blepharitis confirmed by an eye care provider, 58% said they had never previously been diagnosed with blepharitis. The most commonly used management approaches for Demodex blepharitis were artificial tears (47%), warm compresses (32%), and lid wipes (14%). Conclusion Demodex blepharitis has a significant negative impact on daily activities and the mental and physical well-being of afflicted patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Elizabeth Yeu
- Virginia Eye Consultants, Norfolk, VA, USA
- Correspondence: Elizabeth Yeu, Virginia Eye Consultants, 241 Corporate Boulevard, Suite 210, Norfolk, VA, 23502, USA, Tel +1 757 793 4942, Fax +1 757 319 2493, Email
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Antiparasitic Activity of Tea Tree Oil (TTO) and Its Components against Medically Important Ectoparasites: A Systematic Review. Pharmaceutics 2022; 14:pharmaceutics14081587. [PMID: 36015213 PMCID: PMC9416580 DOI: 10.3390/pharmaceutics14081587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/14/2022] [Accepted: 07/22/2022] [Indexed: 12/04/2022] Open
Abstract
Ectoparasites are pathogens that can infect the skin and cause immense pain, discomfort, and disease. They are typically managed with insecticides. However, the fast-emerging antimicrobial resistance and the slow rate of development of new bio-actives combined with environmental and health concerns over the continued use of neurotoxic insecticides warrant newer and alternative methods of control. Tea tree oil (TTO), as an alternative agent, has shown remarkable promise against ectoparasites in recent studies. To our knowledge, this is the first systematic review to assess preclinical and clinical studies exploring the antiparasitic activity of TTO and its components against clinically significant ectoparasites, such as Demodex mites, scabies mites, house dust mites, lice, fleas, chiggers, and bed bugs. We systematically searched databases, including PubMed, MEDLINE (EBSCOhost), Embase (Scopus), CENTRAL, Cochrane Library, CINAHL, ScienceDirect, Web of Science, SciELO, and LILACS in any language from inception to 4 April 2022. Studies exploring the therapeutic activity of TTO and its components against the ectoparasites were eligible. We used the ToxRTool (Toxicological data reliability assessment) tool, the Joanna Briggs Institute (JBI) critical appraisal tools, and the Jadad scale to assess the methodological qualities of preclinical (in vitro and in vivo) studies, non-randomised controlled trials (including cohort, case series, and case studies), and randomised controlled trials, respectively. Of 497 identified records, 71 studies were included in this systematic review, and most (66%) had high methodological quality. The findings of this review revealed the promising efficacy of TTO and its components against ectoparasites of medical importance. Most importantly, the compelling in vitro activity of TTO against ectoparasites noted in this review seems to have translated well into the clinical environment. The promising outcomes observed in clinical studies provide enough evidence to justify the use of TTO in the pharmacotherapy of ectoparasitic infections.
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Craig JP, Bitton E, Dantam J, Jones L, Ngo W, Wang MTM. Short-term tolerability of commercial eyelid cleansers: A randomised crossover study. Cont Lens Anterior Eye 2022; 45:101733. [PMID: 35842288 DOI: 10.1016/j.clae.2022.101733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the short-term tolerability of five commercially available anti-demodectic eyelid cleansers; OCuSOFT Oust Demodex (OD), I-MED I-Lid'n Lash Plus (ILL+), Labtician BlephaDex (BD), Chrissanthe Eye Cleanse (EC), and Théa Blephademodex (BDdx). METHODS Thirty healthy non-contact lens wearers (18 female; mean ± SD age, 33 ± 12 years) were enrolled in a prospective randomised crossover study. On separate visits, spaced at least 48 h apart, participants were randomised to receive topical application of one of five eyelid cleansers or saline. Participants rated subjective ocular discomfort during the 10-minute post-application period. Visual acuity, non-invasive tear film stability, conjunctival hyperaemia, and ocular surface staining were assessed at baseline and 10 min. RESULTS No inter-group differences in ocular parameters were noted at baseline (all p > 0.05). Ocular discomfort scores significantly exceeded baseline scores for 60 s following BD application, 120 s with OD, 135 s with BDdx, 150 s with ILL+, and 195 s with EC (all p < 0.05). Deterioration in non-invasive tear film stability, limbal conjunctival hyperaemia, as well as corneal, conjunctival, and lid margin staining was detected following EC application (all p < 0.05), and increased bulbar conjunctival hyperaemia was observed following both EC and ILL+ treatment (both p < 0.05). CONCLUSIONS Study outcomes highlight varying tolerability profiles with different anti-demodectic lid cleanser preparations, and the potential to induce tear film instability, conjunctival hyperaemia and ocular surface staining on application. Awareness of possible adverse effects arising from topical application of commercial anti-demodectic lid cleanser formulations may help clinicians set realistic patient expectations and encourage better compliance in their use of lid hygiene therapies.
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Affiliation(s)
- Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; École d'optométrie, Université de Montréal, Quebec, Canada; Centre for Ocular Research and Education, School of Optometry and Vision Science, University of Waterloo, Ontario, Canada.
| | - Etty Bitton
- École d'optométrie, Université de Montréal, Quebec, Canada
| | - Jaya Dantam
- Centre for Ocular Research and Education, School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - Lyndon Jones
- Centre for Ocular Research and Education, School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - William Ngo
- Centre for Ocular Research and Education, School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
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Trattler W, Karpecki P, Rapoport Y, Sadri E, Schachter S, Whitley WO, Yeu E. The Prevalence of Demodex Blepharitis in US Eye Care Clinic Patients as Determined by Collarettes: A Pathognomonic Sign. Clin Ophthalmol 2022; 16:1153-1164. [PMID: 35449733 PMCID: PMC9017705 DOI: 10.2147/opth.s354692] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
| | | | | | - Ehsan Sadri
- Visionary Eye Institute, Newport Beach, CA, USA
| | | | | | - Elizabeth Yeu
- Virginia Eye Consultants, Norfolk, VA, USA
- Correspondence: Elizabeth Yeu, Virginia Eye Consultants, 241 Corporate Boulevard, Suite 210, Norfolk, VA, 23502, Tel +1 757 793 4942, Fax +1 757 319 2493, Email
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Safety and Efficacy of Topical Lotilaner Ophthalmic Solution 0.25% for the Treatment of Demodex Blepharitis: A Pilot Study. J Ophthalmol 2021; 2021:3862684. [PMID: 34603770 PMCID: PMC8481060 DOI: 10.1155/2021/3862684] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Evaluate safety and efficacy of topical lotilaner ophthalmic solution, 0.25% for the treatment of Demodex blepharitis. Patients and Methods. 15 patients with Demodex blepharitis, defined as >10 collarettes on the upper lid, lid margin erythema, and Demodex density of ≥1.5 mites/lash on microscopy, were treated bid for 28 days with lotilaner ophthalmic solution, 0.25%. Contact lens wear, artificial eyelashes, and lid structural abnormalities were among the exclusion criteria. No other antibacterial, antiparasitic, or anti-inflammatory treatment or lid hygiene products were permitted. Patients were assessed on Days 7, 14, 28, 60, and 90. Outcome measures were changes in collarette grade and mite density on Day 28. Adverse events and changes in intraocular pressure (IOP), corrected distance visual acuity (CDVA), and slit-lamp biomicroscopy were assessed. Results Mean collarette grade (upper lids) improved from 3.07 ± 0.21 to 0.79 ± 0.19 on Day 28; the change was statistically significant for both upper and lower lids from Day 14 on. Mean mite density per lash decreased from 2.28 ± 0.16 at baseline to 0.14 ± 0.05 at Day 28 (p < 0.0001). Mite eradication (0 mites) was documented in 57.1% of eyes. The effects were durable through Day 90. There were no adverse events and little to no change in CDVA or IOP. The drop was well tolerated, with no discontinuations due to ocular irritation. Conclusion Topical lotilaner ophthalmic solution, 0.25% for 4 weeks, showed promising efficacy for the treatment of Demodex blepharitis. This novel treatment appears to be safe and well tolerated. Randomized controlled studies are needed to confirm the results.
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Jacobi C, Doan S, Pavel V, Chiambaretta F, Kärcher T. Different Approach to Manage Demodex Blepharitis - Initial and Maintenance Treatment. Curr Eye Res 2021; 47:352-360. [PMID: 34565266 DOI: 10.1080/02713683.2021.1978099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE/AIM OF THE STUDY To evaluate the improvement of ocular signs and symptoms in patients suffering from Demodex blepharitis using a combined treatment approach: use of eyelid wipes impregnated with 2.5% terpinen-4-ol (T4O) and 0.2% hyaluronic acid (HA) in the initial treatment period and investigation of maintenance of the treatment effect with the use of eyelid cleansing wipes. MATERIALS AND METHODS Fifty patients with Demodex blepharitis were treated in the initial treatment period with sterile eyelid T4O impregnated wipes for 28 days. In the following four-week maintenance period, 82% patients received sterile eyelid maintenance wipes, while 16% continued treatment with T4O impregnated wipes. Global ocular discomfort, adapted TOSS, SANDE score, and individual blepharitis symptoms were assessed by patients at day 28 and day 56. Ocular signs were evaluated by the investigator at the study visits. Investigator's assessment of the overall treatment performance, patient's assessment of treatment satisfaction, and tolerability were evaluated with questionnaires. RESULTS All global ocular discomfort symptoms and disease specific symptoms assessed by patients as well as all parameters evaluated by the investigators significantly improved in the initial treatment period with the application of eyelid wipes impregnated with 2.5% terpinen-4-ol until day 28. The therapeutic effect was maintained or even improved during the maintenance period under administration of mainly eyelid maintenance wipes until day 56. Both products were well tolerated. No adverse events and no clinically relevant changes in visual acuity were observed during both periods. CONCLUSIONS Once daily treatment with T4O impregnated eyelid wipes in the initial treatment period significantly improved the ocular symptoms and signs and reduced the mite count in patients with Demodex blepharitis within four-weeks administration. Subsequent maintenance treatment with maintenance wipes for another 4 weeks preserved or further intensified the treatment success. The products were well tolerated and were convenient to use.
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Affiliation(s)
- Christina Jacobi
- Ophthalmology Private Practice, Nuremberg, Germany.,Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
| | - Serge Doan
- Fondation a de Rothschild, Paris, France
| | - Viktoria Pavel
- proDERM Institute for Applied Dermatological Research, Hamburg, Germany
| | - Frédéric Chiambaretta
- University Hospital of Clermont-Ferrand, Chu Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France.,Genetic Reproduction and Development Laboratory (Gred), Translational Approach to Epithelial Injury and Repair Team, Clermont-Ferrand, France
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Salinas RG, Karpecki P, Yeu E, Holdbrook M, Baba SN, Ceballos JC, Massaro-Corredor M, Corredor-Ortega C, Ramos-Betancourt N, Quiroz-Mercado H. Safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to demodex infestation: A randomized, controlled, double-masked clinical trial. Cont Lens Anterior Eye 2021; 45:101492. [PMID: 34332895 DOI: 10.1016/j.clae.2021.101492] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to Demodex infestation compared to vehicle control. METHODS In this phase II, randomized, controlled, double-masked clinical trial, 60 eligible participants with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either topical lotilaner ophthalmic solution, 0.25% (Tarsus Pharmaceuticals, Inc., Irvine, CA) (study group) or the vehicle without lotilaner (control group) bilaterally twice a day for 28 days. Participants were followed at Days 7, 14, 28, 60 and 90. The efficacy parameters were change in collarette grade and Demodex density at Day 28. Safety parameters were adverse events, changes in corrected distance visual acuity (CDVA), intraocular pressure (IOP) and slit-lamp biomicroscopy. RESULTS The study group showed a statistically significant decrease in collarette grade compared to the control group beginning at Day 14 (p = 0.003) in the upper eyelid and at Day 28 (p = 0.003) in the lower eyelid. Decreases in both lids were maintained through Day 90 (p < 0.001). At Day 28, mite eradication was achieved in 66.7% and 25.9% of eyes in the study and control group (p = 0.005); at Day 90, these proportions were 68.2% and 18.5% (p = 0.001), respectively. No serious adverse events or clinically significant changes in CDVA and IOP were observed. CONCLUSION For Demodex blepharitis, treatment with lotilaner ophthalmic solution, 0.25% for 4 weeks is safe and effective. The improvement in collarette grade and mite density observed during the treatment period persisted for at least two months following treatment cessation.
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Du J, Gao R, Zhao J. The Effect of Volatile Oil from Chinese Mugwort Leaf on Human Demodecid Mites In Vitro. Acta Parasitol 2021; 66:615-622. [PMID: 33394383 DOI: 10.1007/s11686-020-00314-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human demodecid mites including Demodex folliculorum and Demodex brevis Akbulatova can cause acne, rosacea, epifolliculitis, blepharitis, seborrheic dermatitis, perioral dermatitis, acromastitis and such skin health problems. Artemisia (Composiate) are widely distributed in temperate regions in the northern hemisphere. It has been reported that 17 species of plants in Artemisia used to be mugwort in China. Mugwort volatile oil (MVO) has antibacterial and antiviral effects, can relieve cough and asthma, acts as an expectorant, choleretic and sedative, and promotes circulation and enhances immunity. PURPOSE This research was to observe the effect of MVO on two types of human demodecid mites in vitro. METHODS The MVO was obtained via the supercritical CO2 extraction method, and the human demodecid mites were acquired with cellophane tape. MVO had a distinct killing effect on two types of human demodecid mites, Demodex folliculorum and Demodex brevis. The body of the demodecid mites has a classical temporal process, which consists of excitement, contractions, death and transparency. The killing time was lengthened with decreasing concentration, thus showing an evident dependence on concentration. RESULTS The experiment showed that 3.125% was the minimum effective concentration of MVO for killing D. brevis, and 6.25% was the minimum effective concentration for killing D. folliculorum; the killing effect of MVO on D. brevis was greater than on D. follilorum. CONCLUSION This result suggests that mugwort, which acts as a traditional Chinese herbal medicine, has a noticeable killing effect on human demodecid mites.
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Affiliation(s)
- Jiajun Du
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210000, Jiangsu, China
- Department of Medical Parasitology, Wannan Medical College, Wuhu, 241002, Anhui, China
| | - Rui Gao
- Hefei Infectious Disease Hospital, Hefei, 230001, Anhui, China
- Department of Medical Parasitology, Wannan Medical College, Wuhu, 241002, Anhui, China
| | - Jinhong Zhao
- Department of Medical Parasitology, Wannan Medical College, Wuhu, 241002, Anhui, China.
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Martínez-Pulgarín DF, Ávila MY, Rodríguez-Morales AJ. Interventions for Demodex blepharitis and their effectiveness: A systematic review and meta-analysis. Cont Lens Anterior Eye 2021; 44:101453. [PMID: 33972176 DOI: 10.1016/j.clae.2021.101453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE A systematic review and meta-analysis was performed to evaluate the effectiveness of interventions in the treatment ofDemodex blepharitis in adult patients. METHODS A systematic review and meta-analysis of studies reporting the efficacy of treatments forDemodex blepharitis in the main databases (PubMed / Scopus / Cochrane / EMBASE / Science Direct / WOS / Scielo / Google Scholar / metaRegister of Controlled Trials / ClinicalTrials.gov/ WHO ICTRP) until November 24, 2020 was performed according to the PRISMA statement for meta-analysis. RESULTS Overall, 18 studies were included for 29 different interventions in 1195 participants with 1574 eyes that were positive for Demodex Spp. Demodex counts, total eradication, clinical improvement, Ocular Surface Disease Index, Tear Break-Up Time, cylindrical dandruff, Schirmer test, osmolarity and adverse reactions were analysed, and stratified sub-analyses conducted. The overall effects for Demodex count (mean difference), total eradication (risk ratio) and adverse reactions (risk difference) were -2.07 (95 % CI -3.99 to -0.15) p = 0.03, 1.84 (95 % CI 1.27-2.66) p = 0.001 and 0.24 (95 % CI 0.08 to 0.41) p = 0.005, respectively. The most frequent interventions evaluated in the included studies were tea tree oil (TTO) and its derivatives, such as terpinen 4-ol. CONCLUSION Multiple therapeutic choices were evaluated in this meta-analysis. Pharmacological interventions were superior to non-pharmacological (mechanical, thermal and pulsed light) interventions. It was not possible to establish significant differences between TTO and non-TTO-derived treatments. Adverse reactions were more frequent in TTO-derived treatments, however all were mild. It is necessary to execute studies with longer follow-up times to determine whether re-infestation occurs after the administration of different treatments.
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Affiliation(s)
- Dayron F Martínez-Pulgarín
- Department of Ophthalmology, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia; Basic and Clinic Ophthalmology Research Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Marcel Y Ávila
- Department of Ophthalmology, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia; Basic and Clinic Ophthalmology Research Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Alfonso J Rodríguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de las Americas, Pereira, Risaralda, Colombia
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Ben Hadj Salah W, Baudouin C, Doan S, Angoulvant A, Gottlieb J, Bénichou J, Da Cunha E, Eid L, Labetoulle M, Rousseau A. [Demodex and ocular surface disease]. J Fr Ophtalmol 2020; 43:1069-1077. [PMID: 33127178 DOI: 10.1016/j.jfo.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/08/2020] [Accepted: 08/24/2020] [Indexed: 12/12/2022]
Abstract
Demodex is a saprophytic mite of the ocular adnexa, which can in certain circumstances proliferate on the skin of the face and on the eyelid margins. It is involved in facial rosacea (especially in the papulopustular form) and in the development or aggravation of anterior and/or posterior blepharitis or even keratoconjunctivitis, often in association with cutaneous lesions ; the pathophysiology is often multifactorial. Symptoms are non-specific, but the presence of cylindrical sleeves on the eyelashes is very suggestive of infestation, and certain techniques of biomicroscopic examination or imaging, such as confocal microscopy in vivo, allow direct visualization of the parasite. Parasitological examination of the eyelashes can confirm the diagnosis and can be improved by good sampling technique. Eyelid hygiene and oil-based ointments are the cornerstone of treatment. New specific treatments, in particular topical treatments based on tea tree oil, ivermectin, as well as pulsed light therapy and micro-exfoliation of the eyelid margin, can help to reduce the parasitic load and improve symptoms.
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Affiliation(s)
- W Ben Hadj Salah
- Service d'ophtalmologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France
| | - C Baudouin
- Services d'ophtalmologie, CHNO des XV-XX, et hôpital Ambroise-Paré, Assistance Publique-Hôpitaux de Paris, université Versailles-St-Quentin-en-Yvelines, IHU de Sight Restore Saclay, Paris, France; Institut de la vision, Sorbonne université, Inserm, CNRS, Sorbonne, France
| | - S Doan
- Service d'ophtalmologie, CHU de Bichat, Assistance Publique-Hôpitaux de Paris et Fondation ophtalmologique Rothschild, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France
| | - A Angoulvant
- Service de parasitologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, Paris, France
| | - J Gottlieb
- Service d'immunologie clinique & consultation de dermatologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, Paris, France
| | - J Bénichou
- Service d'ophtalmologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France
| | - E Da Cunha
- Service d'ophtalmologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France
| | - L Eid
- Service d'ophtalmologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France
| | - M Labetoulle
- Service d'ophtalmologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France; Département immunologie des maladies virales, auto-immunes, bactériennes et hématologiques (IMVA-HB). UMR 1184, CEA, Fontenay-Aux-Roses, France
| | - A Rousseau
- Service d'ophtalmologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France; Département immunologie des maladies virales, auto-immunes, bactériennes et hématologiques (IMVA-HB). UMR 1184, CEA, Fontenay-Aux-Roses, France.
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Abstract
Demodex is the most common parasite living on humans and yet little is understood about its pathogenicity with respect to the ocular surface. An increasing interest in Demodex over the past 20-years has increased our understanding of this mite and its pathogenetic role. This article begins with a review of the anatomy, life cycle, mode of transmission and advances in genetics that can distinguish between Demodex folliculorum and Demodex brevis, the only two Demodex species in humans. Additionally, a review of diagnostic procedures and existing and emerging ocular and systemic management options are presented. Despite the increasing interest in Demodex in the literature, there remains numerous obstacles for future studies, hence a section of this review is dedicated to the identification and proposal for future considerations. The lack of uniformity with respect to terminology, diagnostic technique and management approach for Demodex remain as obstacles for future study comparisons. This review summarised the current knowledge on Demodex and hopes to offer some recommendations for future directions in the study of Demodex in humans.
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Affiliation(s)
- Etty Bitton
- École d'optométrie, Université de Montréal, Montreal, Québec, Canada
| | - Sarah Aumond
- École d'optométrie, Université de Montréal, Montreal, Québec, Canada
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26
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Gostimir M, Allen LH. Is there enough evidence for the routine recommendation of eyelid wipes? A systematic review of the role of eyelid wipes in the management of blepharitis. Can J Ophthalmol 2020; 55:424-436. [PMID: 32835674 DOI: 10.1016/j.jcjo.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Eyelid wipes are routinely recommended for blepharitis, but these do not come without financial cost and potential adverse effects. This review aimed to provide a comprehensive summary of existing evidence for the efficacy and safety of eyelid wipes in the management of blepharitis. METHODS A search of Medline and Embase was conducted to identify studies that assessed the efficacy of an eyelid wipe option. Studies that included other interventions were excluded, as well as studies that evaluated warm compresses. Risk of bias, adverse effects, cost, and availability assessments were also performed. RESULTS After the review of 1650 search results, 16 studies were included. A variety of eyelid wipes were studied, including common household products, tea tree oil-based products, commercial solutions, and commercial wipes. Some efficacy was demonstrated for all options that were studied, and most improvements were noted within 1 or 2 months. There was not enough evidence to determine the relative efficacy of different options. There was significant heterogeneity, and all nongeneric options were limited to 1 study, which precluded meta-analysis. The risk of bias assessment revealed concerns regarding the quality of evidence, and notably, several studies were supported by the manufacturing company. CONCLUSIONS Although some efficacy has been demonstrated for several types of eyelid wipes, including common household products, there remains a lack of robust evidence to support their routine recommendation. Long-term costs and potential adverse effects should not be overlooked. There is not enough evidence to suggest superiority of one option over others.
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Affiliation(s)
| | - Larry H Allen
- Ivey Eye Institute, Western University, London, Ont..
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Comparison of the efficacy of tea tree ( Melaleuca alternifolia) oil with other current pharmacological management in human demodicosis: A Systematic Review. Parasitology 2020; 147:1587-1613. [PMID: 32772960 DOI: 10.1017/s003118202000150x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Various treatments are found to be moderately effective in managing Demodex-related diseases except tea tree oil (TTO) and terpinen-4-ol (T4O), which showed superior miticidal and anti-inflammatory effects in numerous clinical studies. Their possible effects include lowering mite counts, relieving Demodex-related symptoms, and modulating the immune system. This review summarizes the current clinical topical and oral treatments in human demodicosis, their possible mechanisms of action, side-effects and resistance in treating this condition. TTO (especially T4O) is found to be the most effective followed by metronidazole, ivermectin and permethrin in managing the disease. This is because TTO has anti-parasitic, anti-bacterial, anti-fungal, anti-inflammatory and wound-healing effects. Furthermore, nanoTTO can even release its contents into fungus and Pseudomonas biofilms. Combinations of different treatments are occasionally needed for refractory cases, especially for individuals with underlying genetic predisposal or are immuno-compromised. Although the current treatments show efficacy in controlling the Demodex mite population and the related symptoms, further research needs to be focused on the efficacy and drug delivery technology in order to develop alternative treatments with better side-effects profiles, less toxicity, lower risk of resistance and are more cost-effective.
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28
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Zhang AC, Muntz A, Wang MTM, Craig JP, Downie LE. Ocular Demodex: a systematic review of the clinical literature. Ophthalmic Physiol Opt 2020; 40:389-432. [PMID: 32691894 DOI: 10.1111/opo.12691] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE There is increasing clinical and research interest in the potential contribution of Demodex to ocular surface disease. The aim of this systematic review was to summarise and synthesise current clinical evidence relating to the aetiology, diagnosis and treatment of ocular Demodex. RECENT FINDINGS A comprehensive literature search was performed in OVID Medline, OVID Embase, and clinical trial registries, for studies published between 1990 and August 2019, examining Demodex on the ocular surface. The review included primary clinical research studies and systematic reviews of primary clinical research studies, where Demodex was considered in the context of the ocular surface and/or adnexa. Studies were categorised using the National Health and Medical Research Council evidence hierarchy. Risk of bias assessment was performed using validated tools for studies categorised as providing Level I or II evidence. A total of 87 studies were eligible for inclusion, including two systematic reviews. Most studies (60%) were observational, describing the prevalence of ocular Demodex in different clinical populations. There was a high degree of variability in the epidemiological data derived from cross-sectional aetiology studies. There was mostly consistent evidence to support an association between ocular Demodex and chronic blepharitis. Seven diagnostic test-accuracy studies were identified, which considered a range of techniques, including slit lamp examination for cylindrical eyelash collarettes and/or eyelash manipulation techniques, light microscopic evaluation of epilated eyelashes and in vivo confocal microscopy. There is currently no accepted gold-standard diagnostic method for ocular Demodex. For intervention studies, there was one systematic review, 11 published randomised trials, six trial registry entries, and nine case series. Despite a number of recent trials, the appropriate treatment regimen for ocular Demodex (including the optimal criteria and timing of an intervention) is not clearly established. CONCLUSIONS This comprehensive narrative synthesis has captured the landscape of clinical evidence relating to the prevalence, aetiology, diagnosis and treatment of ocular Demodex. There remain opportunities to enhance understanding of its role in ocular surface disease, best diagnostic approaches and optimal treatment protocols.
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Affiliation(s)
- Alexis Ceecee Zhang
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Alex Muntz
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
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