Efficacy of Topical Ivermectin 1% in the Treatment of Demodex Blepharitis

Young Choi, Youngsub Eom, Eun Gyu Yoon, Jong Suk Song, Il-Hwan Kim, Hyo Myung Kim, Young Choi, Youngsub Eom, Eun Gyu Yoon, Jong Suk Song, Il-Hwan Kim, Hyo Myung Kim

Abstract

Purpose: The purpose of this study was to evaluate the efficacy of topical ivermectin 1% cream application on the eyelashes in combination with eyelid hygiene in the treatment of Demodex blepharitis.

Methods: One hundred two eyes of 102 patients with symptomatic Demodex blepharitis were divided into 2 groups according to the use of topical ivermectin in this retrospective case-control study. The ivermectin group (n = 51) applied topical ivermectin 1% cream on the eyelashes for 15 minutes once weekly, but the control group (n = 51) did not. In both groups, eyelid hygiene was performed once daily. The Standard Patient Evaluation of Eye Dryness (SPEED) symptom questionnaire score, Oxford staining score, eyelid debris, eyelid redness/swelling, and telangiectasia were assessed during the follow-up visits.

Results: The mean follow-up periods of the ivermectin and control groups were 15.1 ± 9.7 weeks and 14.8 ± 8.6 weeks, respectively. The SPEED score and eyelid debris grade were significantly improved in both groups during the follow-up, although the SPEED score and eyelid debris grade showed greater changes in the ivermectin group than in the control group. The Oxford staining score, eyelid redness/swelling grade, and telangiectasia grade were significantly improved only in the ivermectin group but not in the control group.

Conclusions: In patients with Demodex blepharitis, the use of topical ivermectin 1% cream for 15 minutes once weekly in addition to eyelid hygiene had more significantly improved symptoms, ocular surface staining, eyelid debris, redness/swelling, and telangiectasia as compared with eyelid hygiene alone. These findings support the efficacy of topical ivermectin 1% cream application in the treatment of Demodex blepharitis.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

Figures

FIGURE 1.
FIGURE 1.
Confirmation of the presence of Demodex. Demodex was observed under a microscope by pulling eyelashes from eyelids.
FIGURE 2.
FIGURE 2.
Comparison of subjective symptom scores between the ivermectin and control groups. The SPEED questionnaire was used to assess the symptom score (0–28 points). The asterisk indicates statistically significant changes in the SPEED score in the ivermectin group. The dagger indicates statistically significant changes in the SPEED score in the control group. The double dagger indicates statistically significant differences between the ivermectin and control groups. The asterisk, dagger, and double dagger indicate P < 0.05 per repeated-measures ANOVA with Tukey's HSD post hoc test. ANOVA, analysis of variance; HSD, honestly significant difference.
FIGURE 3.
FIGURE 3.
Comparison of Oxford staining scores between ivermectin and control groups. The asterisk indicates statistically significant changes in the Oxford staining score in the ivermectin group. The asterisk indicates P < 0.05 per repeated-measures ANOVA with Tukey's HSD post hoc test. ANOVA, analysis of variance; HSD, honestly significant difference.
FIGURE 4.
FIGURE 4.
Comparison of eyelid debris grade between the ivermectin and control groups. The asterisk indicates statistically significant changes in the eyelid debris grade in the ivermectin group. The dagger indicates statistically significant changes in the eyelid debris grade in the control group. The double dagger indicates statistically significant differences between the ivermectin and control groups. The asterisk, dagger, and double dagger indicate P < 0.05 per repeated-measures ANOVA with Tukey's HSD post hoc test. ANOVA, analysis of variance; HSD, honestly significant difference.
FIGURE 5.
FIGURE 5.
Anterior-segment photographs of the right eye of a 78-year-old man treated with a combination of topical ivermectin 1% cream and eyelid hygiene. A, Baseline and (B) post-treatment (+6 wk) photographs show improvement in eyelid debris grade.
FIGURE 6.
FIGURE 6.
Comparison of eyelid redness/swelling grade between the ivermectin and control groups. The asterisk indicates statistically significant changes in the eyelid redness/swelling grade in the ivermectin group. The double dagger indicates statistically significant differences between the ivermectin and control groups. The asterisk and double dagger indicate P < 0.05 per repeated-measures ANOVA with Tukey's HSD post hoc test. ANOVA, analysis of variance; HSD, honestly significant difference.
FIGURE 7.
FIGURE 7.
Anterior-segment photographs of the right eye of a 54-year-old woman who treated with a combination of topical ivermectin 1% cream and eyelid hygiene. A, Baseline and (B) post-treatment (+5 wk) photographs show improvement in eyelid redness/swelling and telangiectasia grade.
FIGURE 8.
FIGURE 8.
Comparison of eyelid telangiectasia grade between the ivermectin and control groups. The asterisk indicates statistically significant changes in the eyelid telangiectasia grade in the ivermectin group. The double dagger indicates statistically significant differences between the ivermectin and control groups. Both the asterisk and double daggers indicate P < 0.05 per repeated-measures ANOVA with Tukey's HSD post hoc test. ANOVA, analysis of variance; HSD, honestly significant difference.

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