Demodex Blepharitis
An evidence-based overview of Demodex blepharitis, including causes, diagnosis, treatment, and long-term management.
Eyelid Disorder
H01.00–H01.009 (Blepharitis)
Demodex folliculorum / D. brevis
Yes
Overview
Demodex blepharitis is chronic inflammation of the eyelid margins caused by infestation with Demodex mites. These mites inhabit eyelash follicles and meibomian glands, leading to eyelid irritation, inflammation, meibomian gland dysfunction, and ocular surface disease. Cylindrical dandruff (collarettes) at the base of the eyelashes is considered the hallmark clinical sign.
Symptoms & Signs
- Itchy eyelids, especially on waking
- Foreign body sensation
- Burning and redness
- Collarettes around eyelashes
- Crusting and lash loss (madarosis)
- Dry eye symptoms and fluctuating vision
Risk Factors
- Increasing age
- Rosacea
- Meibomian gland dysfunction
- Chronic blepharitis
- Compromised immune function
- Poor eyelid hygiene
Diagnosis
- Slit-lamp examination
- Identification of collarettes at lash bases
- Eyelash epilation with microscopic mite confirmation (when needed)
- Assessment of meibomian gland function
- Evaluation for associated dry eye disease
Differential Diagnosis
| Condition | Distinguishing Feature |
|---|---|
| Anterior staphylococcal blepharitis | Hard crusting without typical collarettes |
| Seborrheic blepharitis | Greasy scales |
| Allergic conjunctivitis | Marked itching and chemosis |
| Dry eye disease | Tear film instability predominates |
Treatment
- Daily eyelid hygiene
- Warm compresses and lid cleansing
- Tea tree oil-derived lid cleansers (selected patients)
- Lotilaner ophthalmic solution 0.25% when appropriate
- Management of meibomian gland dysfunction and dry eye
- Regular follow-up for recurrent disease
Complications
- Chronic blepharitis
- Recurrent chalazia and hordeola
- Meibomian gland dysfunction
- Dry eye disease
- Corneal irritation
Coding
There is no unique ICD-10-CM diagnosis code specifically for Demodex blepharitis. Most clinicians report the appropriate blepharitis code (H01.00-H01.009) and document the presence of Demodex infestation in the clinical record.
Frequently Asked Questions
What are collarettes?
Collarettes are cylindrical sleeves of keratin and debris surrounding the base of eyelashes and are considered the pathognomonic sign of Demodex blepharitis.
Can Demodex blepharitis recur?
Yes. Recurrence is common, so ongoing eyelid hygiene and follow-up are often necessary.
Medical Disclaimer
The information provided on Kardia Vision is for educational purposes only and should not replace professional medical advice, diagnosis, or treatment. Consult an eye care professional if you experience persistent eyelid irritation, redness, pain, or changes in vision.