A Delphi approach to establishing consensus on best practice for the diagnosis and treatment of Demodex blepharitis.

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.

Demodex Blepharitis: A Survey-Based Approach to Investigate Knowledge, Attitudes, and Practices Among Optometrists in India.

Purpose: To investigate the knowledge, attitudes, and practice towards Demodex blepharitis among optometrists in India. Methods: The study was conducted in the form of an online survey using Research Electronic Data Capture (REDCap). The survey link was distributed via direct e-mail and social media platforms, and it was comprised of 20 questions divided into two sections. The first section focused on the practitioners' demographics and their views on the general health of the eyelid. The second section of the survey was specific and aimed at obtaining information on identifying and treating Demodex blepharitis, and was only completed by those respondents who looked for Demodex mites. Results: The survey was completed by 174 optometrists. The prevalence of blepharitis in the general population was judged by the respondents to be 40%, whereas the prevalence of Demodex mites was estimated to be 29%. Interestingly, the prevalence of Demodex mites in people with blepharitis was estimated to be 30%. This estimated prevalence was substantially lower than that reported in the literature on the subject. 66% of participants believed Demodex mites to be a significant cause of ocular discomfort, whereas only 30% of participants would intervene to diagnose and manage Demodex blepharitis in their patients. Optometrists differed in their preferred method of diagnosis and management of Demodex infestation in eyelids. Conclusion: The result of this survey suggests that Demodex blepharitis is a highly under-diagnosed condition in India, with nearly 30% of surveyed optometrists managing this condition. The study also observed a lack of awareness and consensus among surveyed optometrists with regards to diagnosis and appropriate treatment methods to control Demodex infestation in eyelids.