What’s new in treating Blepharitis?
During my time at the national eye meeting in Chicago earlier this month, there was a big focus on a new treatment for Demodex-related blepharitis. At the booth representing Tarsus - the company making this new treatment medication, they offered to take pictures of attendees - so I naturally volunteered. Yes, the awful photo of my face titled “AAO 2022 / Chicago, IL” is what you see below. Fortunately, my eyelids looked quite clean (thanks to my daily routine of Zocuwipes and Avenova lid hygiene - I’ve posted on this earlier) - though my face shows off my significant rosacea, fine lines and extra skin - called dermatochalasis - which basically means I’m overdue for my IPL and RadioFrequency lid treatments.
The photo beneath my photo is of a patient’s eyelids that I took through the eyepiece of my office slitlamp (a kind of microscope we eye doctors use to help us examine our eye patients). That poor patient has a lot of blepharitis - and the waxy “collars” around the base of the lashes illustrates the typical finding we see in eyelids that are “colonized” (in this case, overrun) with Demodex - the tiny skin mite that commonly lives in and around eyelashes. They subsist off eyelid oils and germs that live off our tears. Unfortunately, they are quite prevalent (if you go by age, the likelihood that you will carry these mites goes up approximately 10% per decade - so by age 50, you have a 50:50 chance you have them - and by that equation, by age 100, you would be certain to have them) - but as with all statistics - it only matters if it affects you.
If you have these mites - and if you have resistant skin, then you may not know you have them - you might not care - and it might not matter. However, if you have sensitive skin (common in ocular rosacea, like I have), then the life cycle (which I won’t get into, as it would likely keep you up all night like a bad horror movie) is likely to be like adding gasoline to a flame. This causes irritation that leads to inflammation that fans the flames of dry eye disease. Tarsus is repurposing a veterinarian medicine (used to treat dog’s mange) as this medicine has proven extremely effective at knocking off this mite without irritating human eyes or eyelids. Sadly, it is likely to take months (and could be closer to a year) before it passes through the hoops of the FDA and becomes something we eye doctors can prescribe for our patients.
The good news is that there are many treatment options that are already available and can be quite effective. In fact, the BlephEx and ZEST treatments many dry eye specialists use, coupled with ongoing Zocuwipe (or some Tea Tree Oil or TTO-derivative products like Cliradex) and Hypochlorous Acid sprays (like the pure version in Avenova) that I personally prefer (and use) are generally capable of controlling if not eradicating these mites. IPL has also shown good efficacy (see more of my posts on this) and off label use of Ivermectin cream are extra tools we already have. Still, I look forward to another powerful tool to help more of my patients - as insurance companies are yet to cover lid hygiene treatments like BlephEx and ZEST, don’t generally cover IPL, and don’t like us to prescribe off label treatments - so once this new drop is approved by the FDA for this specific indication, it is that much more likely to be covered by insurance - making it more available and affordable for most!
