Efficacy of treatments for Demodex blepharitis: A systematic review and meta-analysis

Valentin Navel*, Aurélien Mulliez, Cédric Benoist d'Azy, Julien Baker, Jean Malecaze, Frédéric Chiambaretta, Frédéric Dutheil

*Corresponding author for this work

Research output: Contribution to journalJournal articlepeer-review

63 Citations (Scopus)


Purpose: We conducted a systematic review and meta-analysis to evaluate the efficacy of different treatment for Demodex blepharitis. Parameters studied were mites count, improvement of symptoms and mites’ eradication, stratified on type of treatments and mode of delivery of treatments (local or systemic). Method: The PubMed, Cochrane Library, Embase, ClinicalTrials.gov, Google scholar and Science Direct databases were searched for studies reporting an efficacy of treatments for Demodex blepharitis. Results: We included 19 studies (14 observational and 5 randomized clinical trials), for a total of 934 patients, 1741 eyes, and 13 different treatments. For mites count, eradication rate, and symptoms improvement, meta-analysis included fifteen, fourteen and thirteen studies, respectively. The overall effect sizes for efficiency of all treatments, globally, were 1.68 (95CI 1.25 to 2.12), 0.45 (0.26–0.64), and 0.76 (0.59–0.90), respectively. Except usual lid hygiene for mites count, Children's Hospital of Eastern Ontario ointment (CHEO) for both eradication rate and symptoms, and CHEO, 2% metronidazole ointment, and systemic metronidazole for eradication rate, all treatments were efficient. Stratified meta-analysis did not show significant differences between local and systemic treatments (1.22, 0.83 to 1.60 vs 2.24, 1.30 to 3.18 for mites count; 0.37, 0.21 to 0.54 vs 0.56, 0.06 to 0.99 for eradication rate; and 0.77, 0.58 to 0.92 vs 0.67, 0.25 to 0.98 for symptoms improvement). Conclusion: We reported the efficiency of the different treatments of Demodex blepharitis. Because of less systemic side effects, local treatments seem promising molecules in the treatment of Demodex blepharitis.

Original languageEnglish
Pages (from-to)655-669
Number of pages15
JournalOcular Surface
Issue number4
Publication statusPublished - Oct 2019

Scopus Subject Areas

  • Ophthalmology

User-Defined Keywords

  • Blepharitis
  • Demodex
  • Immunology
  • Infection
  • Inflammation
  • Ivermectin
  • Metronidazole
  • Pilocarpine
  • Tea tree oil


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