Point-of-Care Perspectives from PatientPoint

XDEMVY: FDA-approved for Demodex blepharitis

by PatientPoint

The first FDA approval for Demodex blepharitis (DB) occurred in 2023. Studies have shown as many as 45% of the 20 million patients with blepharitis have Demodex. More recent studies have shown higher numbers for Demodex in eyecare practices if we know what to look for.

Rendia, a PatientPoint Company, provides the ideal forum for patient education about this disease.

Identifying Demodex blepharitis

Every eye care practitioner (ECP) has the tools to identify DB. The key is to have the patients look down while at the slit lamp. Scan the upper eyelid margins for a sleeve at the base of the lashes, known as a collarette. Although many patients may be asymptomatic, the most common symptoms include itchy eyelid margins, dry eye, irritation, grittiness, debris and hyperemia. Look for associated conditions as well. In my experience, rosacea has a higher incidence of DB.

Why treat Demodex blepharitis?

Not treating demodex blepharitis results in eventual or further patient symptoms, thinning and loss of lashes, scalloped lid margins, intolerance to contact lenses, meibomian gland dysfunction and potentially chronic dry eye disease. Now that we have a new topical drug for treating the disease, we should avoid letting it advance to co-morbid conditions.


This new drug is Lotilaner 0.25% ophthalmic solution. It originates from veterinary medicine in treating Demodex, also known as mange, in dogs. The concentration and formation are different, being a topical ophthalmic drop for humans and being dosed with BID for six weeks. In clinical trials, meaningful and statistical improvement was observed at two weeks, although the drug should be dosed for six weeks. The six-week time frame allows for two cycles of Demodex, including hatching of the eggs and nits. 96% of patients improved at least one collarette grade, and 89% achieved a clinically meaningful cure. Burning upon instillation was the most common adverse event in about 12% of study patients.

Animations and models for Demodex blepharitis education

Patients with collarettes, indicating DB, are often self-conscious if they see images of their eyelids magnified at the slit lamp. It is best to use animations and images like those found in Rendia.

In Exam Mode, under conditions, go to blepharitis, where a progressive animation of Demodex blepharitis can be seen, indicating hyperemia and the presence of collarettes. Then click on the right icon showing the lid margins, and an effective animation quickly takes you through the effects on the meibomian glands.

Under conditions below blepharitis, you can click on demodex to show a precise rendition of the collarettes at the base of the lashes with redness and hyperemia. The treatment tab now shows various effective options to help your patients, including blepharoexfoliation and IPL.

I have also seen good success with an OTC product called Meiboclean, which contains Manuka extract. For most ECPs, XDEMVY will be the ideal choice, prescribed BID for six weeks. With Rendia, patients are comfortably educated about the condition, and a new FDA-approved drug can be prescribed.

Learn how Rendia, a PatientPoint company, can help you educate your patients to improve care, adherence and outcomes.

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