Demodex blepharitis shows negative impact on mental and physical well-being of afflicted patients
Demodex blepharitis is a condition that is commonly encountered in eye care practices. A high prevalence of Demodex blepharitis, ranging from 41% to 70%, has been reported worldwide. Despite the high prevalence of Demodex blepharitis, patients with the condition may go undiagnosed or misdiagnosed for years. Even when Demodex blepharitis is diagnosed, inconsistent and typically suboptimal efficacy with over-the-counter and other management options and the absence of an FDA-approved prescription therapeutic disincentivizes treatment. When the underlying cause goes untreated, the immune-mediated inflammatory processes associated with chronic Demodex blepharitis are detrimental to the eyelid and ocular surface health, presenting as itchy, irritated, and dry eyes, fluctuating and blurred vision, lid and lash abnormalities, ocular surface inflammation, noticeable eye and eyelid erythema, and contact lens intolerance and reduced wear time
O'Dell et al hypothesized that the persistent burden of blepharitis symptoms may also worsen and negatively affect patients' quality of life and may have an impact on health care system resource utilization. In this multicenter, observational, prospective, IRB-approved study, 311 Demodex blepharitis patients aged ≥18 years were included. Demodex blepharitis was diagnosed based on the presence of ≥1.0 mite per lash (upper and lower eyelids combined), >10 collarettes on the upper lashes, and at least mild lid margin erythema of the upper eyelid in at least one eye. All patients were asked to complete a questionnaire about their symptoms, daily activities, quality of life, and management approaches, and descriptive statistics were used to analyze the responses.
More than half the patients had been experiencing symptoms of blepharitis for ≥4 years. The three most frequent and bothersome symptoms experienced by patients were dry eyes, itchiness, and irritation.
Nearly half the patients (47%) responded that they were conscious of their eyes all day, and 23% said that they were constantly worrying about their eyes.
Other activities that were negatively affected included difficulty driving at night (47%), additional time needed for daily hygiene routine (30%), and difficulty in wearing eye make-up (in 34% of females).
While all subjects had objective signs of Demodex blepharitis confirmed by an eye care provider, 58% said they had never previously been diagnosed with blepharitis.
The most commonly used management approaches for Demodex blepharitis were artificial tears (47%), warm compresses (32%), and lid wipes (14%).
Demodex blepharitis is a highly prevalent lid margin disease; still, it is often overlooked or misdiagnosed and, as a result, patients may struggle with the condition for years. Patients with a confirmed diagnosis of Demodex blepharitis were asked questions about ocular symptoms, prior diagnoses, success with over-the-counter and other management options, comorbidities, and daily activities. The analysis of the questionnaire responses shows that Demodex blepharitis is associated with considerable symptomatic and psychosocial burden, negatively affecting daily life in the vast majority of patients with the disease.
The symptoms of Demodex blepharitis seem to impair daily activities and to be long-lasting. As with other lid margin and ocular surface diseases, dryness was the most common symptom reported and one of the most bothersome, as well.
Itch has been identified by other authors as a symptom characteristic of Demodex blepharitis. Ocular irritation, awareness of the eyes and foreign body sensation were also common.
Frequent and bothersome symptoms may affect visual concentration, disrupting productivity and affecting visually demanding tasks such as night driving. Nearly half the patients in the present study reported difficulty driving at night. Degradation of optical quality related to DED has previously been associated with visual impairments during driving; as such, blurred vision (reported by 27% of patients in the present study) may also have contributed to difficulties in night driving.
Untreated chronic disease may have substantial financial implications for affected patients and for the health care system, particularly because many patients experience blepharitis symptoms over long periods of time
The present study also explored the psychosocial impact and appearance-related concerns of patients with Demodex blepharitis. Overall, Demodex blepharitis negatively impacted 80% of patients on psychosocial metrics, including contributing to a negative appearance to others, causing worry and even an altered mental state. Pro-inflammatory cytokines reportedly cross the blood-brain barrier and can induce psychosocial and behavioral changes.
This study is limited by its observational nature and the fact that it relies on patient recollection of symptoms, attempted therapies, doctor visits, and prior diagnoses. However, it confirms that patients with Demodex blepharitis frequently experience and are bothered by ocular symptoms. These patients allocate time and resources to health care appointments and approaches that often do not resolve their symptoms, contributing to individual and health care system costs. Additionally, patients with Demodex blepharitis perceive significant negative effects on their daily activities, mental and physical well-being. Treatments that safely and effectively treat Demodex blepharitis and are simple to use are needed to relieve the symptom burden and reduce psychosocial effects of Demodex blepharitis.
Source: O'Dell et al; Clinical Ophthalmology 2022:16
https://doi.org/10.2147/OPTH.S374530
