Attendees of the lecture, “Focus on the Lids for OSD Success,” which was provided by Melissa Barnett, OD, learned, in part, about another focus for deterring contact lens dropout: identifying Demodex. The presentation occurred Feb. 27, from 10:45 AM to 12:45 PM, in the Georgia World Congress Center, 315/316.

Demodex Reviewed

Demodex (D.) are cigar-shaped ectoparasites that have 4 pairs of legs. D. folliculorum (0.3 mm to 0.4 mm) are located at the base of eyelashes, and D. brevis (0.2 mm to 0.3 mm) can be seen in the sebaceous glands, Dr. Barnett explained.

Demodex deposit debris and digestive enzymes, which can cause inflammation and degeneration of conjunctival tissue, and can alter the composition of meibum, she continued. As a result, these parasites are related to blepharitis, meibomian gland dysfunction, eyelash alterations, including madarosis, trichiasis and triangulation, conjunctivitis, and keratitis. 

Contact Lens Wearers

Dr. Barnett pointed out that Demodex mites have been identified in up to 90% of contact lens wearers. Further, she explained that 93% of contact lens wearers who reported contact lens intolerance had Demodex, while 6% of wearers who had the ectoparasites refuted symptoms of discomfort. Finally, Dr. Barnett revealed a correlation between Demodex and soft contact lens intolerance.

Keeping Wearers

To deter dropout and improve contact lens retention, Dr. Barnett stressed the importance of identifying Demodex via slit lamp with high magnification by asking the patient to close their eyes or look down. This is because even with a lid lift when the patient is looking straight, Demodex, which appear as diffuse collarettes and misdirected or missing lashes, can be missed. She also recommended prescribing lid hygiene and lotilaner ophthalmic solution, which is shown to eradicate Demodex. OM