Efficacy of treatments for Demodex blepharitis: a systematic review and meta-analysis

Valentin Navel, Aurélien Mulliez, Cédric Benoist d'Azy, Julien S. Baker, Jean Malecaze, Frédéric Chiambaretta, Frédéric Dutheil

Research output: Contribution to journalArticle

Abstract

Purpose
We conducted a systematic review and meta-analysis to evaluate the efficacy of different treatment for Demodex blepharitis. Parameters studied were mites count, improvement of symptoms and mites' eradication, stratified on type of treatments and mode of delivery of treatments (local or systemic).

Method

The PubMed, Cochrane Library, Embase, ClinicalTrials.gov, Google scholar and Science Direct databases were searched for studies reporting an efficacy of treatments for Demodex blepharitis.

Results
We included 19 studies (14 observational and 5 randomized clinical trials), for a total of 934 patients, 1741 eyes, and 13 different treatments. For mites count, eradication rate, and symptoms improvement, meta-analysis included fifteen, fourteen and thirteen studies, respectively. The overall effect sizes for efficiency of all treatments, globally, were 1.68 (95CI 1.25 to 2.12), 0.45 (0.26 to 0.64), and 0.76 (0.59 to 0.90), respectively. Except usual lid hygiene for mites count, Children's Hospital of Eastern Ontario ointment (CHEO) for both eradication rate and symptoms, and CHEO, 2% metronidazole ointment, and systemic metronidazole for symptoms, all treatments were efficient. Stratified meta-analysis did not show significant differences between local and systemic treatments (1.22, 0.83 to 1.60 vs 2.24, 1.30 to 3.18 for mites count; 0.37, 0.21 to 0.54 vs 0.56, 0.06 to 0.99 for eradication rate; and 0.77, 0.58 to 0.92 vs 0.67, 0.25 to 0.98 for symptoms improvement).

Conclusion
We reported the efficiency of the different treatments of Demodex blepharitis. Because of less systemic side effects, local treatments seem promising molecules in the treatment of Demodex blepharitis.
Original languageEnglish
JournalThe Ocular Surface
DOIs
Publication statusPublished - 20 Jun 2019

Fingerprint

Demodex
systematic review
meta-analysis
signs and symptoms (animals and humans)
mites
ointments
metronidazole
Ontario
lids
randomized clinical trials
hygiene
eyes
adverse effects

Keywords

  • Demodex
  • Blepharitis
  • Infection
  • Immunology
  • Inflammation
  • Tea tree oil
  • Ivermectin
  • Pilocarpine
  • Metronidazole

Cite this

Navel, Valentin ; Mulliez, Aurélien ; Benoist d'Azy, Cédric ; Baker, Julien S. ; Malecaze, Jean ; Chiambaretta, Frédéric ; Dutheil, Frédéric. / Efficacy of treatments for Demodex blepharitis : a systematic review and meta-analysis. In: The Ocular Surface. 2019.
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abstract = "PurposeWe conducted a systematic review and meta-analysis to evaluate the efficacy of different treatment for Demodex blepharitis. Parameters studied were mites count, improvement of symptoms and mites' eradication, stratified on type of treatments and mode of delivery of treatments (local or systemic).MethodThe PubMed, Cochrane Library, Embase, ClinicalTrials.gov, Google scholar and Science Direct databases were searched for studies reporting an efficacy of treatments for Demodex blepharitis.ResultsWe included 19 studies (14 observational and 5 randomized clinical trials), for a total of 934 patients, 1741 eyes, and 13 different treatments. For mites count, eradication rate, and symptoms improvement, meta-analysis included fifteen, fourteen and thirteen studies, respectively. The overall effect sizes for efficiency of all treatments, globally, were 1.68 (95CI 1.25 to 2.12), 0.45 (0.26 to 0.64), and 0.76 (0.59 to 0.90), respectively. Except usual lid hygiene for mites count, Children's Hospital of Eastern Ontario ointment (CHEO) for both eradication rate and symptoms, and CHEO, 2{\%} metronidazole ointment, and systemic metronidazole for symptoms, all treatments were efficient. Stratified meta-analysis did not show significant differences between local and systemic treatments (1.22, 0.83 to 1.60 vs 2.24, 1.30 to 3.18 for mites count; 0.37, 0.21 to 0.54 vs 0.56, 0.06 to 0.99 for eradication rate; and 0.77, 0.58 to 0.92 vs 0.67, 0.25 to 0.98 for symptoms improvement).ConclusionWe reported the efficiency of the different treatments of Demodex blepharitis. Because of less systemic side effects, local treatments seem promising molecules in the treatment of Demodex blepharitis.",
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Efficacy of treatments for Demodex blepharitis : a systematic review and meta-analysis. / Navel, Valentin; Mulliez, Aurélien; Benoist d'Azy, Cédric; Baker, Julien S.; Malecaze, Jean; Chiambaretta, Frédéric; Dutheil, Frédéric.

In: The Ocular Surface, 20.06.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Efficacy of treatments for Demodex blepharitis

T2 - a systematic review and meta-analysis

AU - Navel, Valentin

AU - Mulliez, Aurélien

AU - Benoist d'Azy, Cédric

AU - Baker, Julien S.

AU - Malecaze, Jean

AU - Chiambaretta, Frédéric

AU - Dutheil, Frédéric

PY - 2019/6/20

Y1 - 2019/6/20

N2 - PurposeWe conducted a systematic review and meta-analysis to evaluate the efficacy of different treatment for Demodex blepharitis. Parameters studied were mites count, improvement of symptoms and mites' eradication, stratified on type of treatments and mode of delivery of treatments (local or systemic).MethodThe PubMed, Cochrane Library, Embase, ClinicalTrials.gov, Google scholar and Science Direct databases were searched for studies reporting an efficacy of treatments for Demodex blepharitis.ResultsWe included 19 studies (14 observational and 5 randomized clinical trials), for a total of 934 patients, 1741 eyes, and 13 different treatments. For mites count, eradication rate, and symptoms improvement, meta-analysis included fifteen, fourteen and thirteen studies, respectively. The overall effect sizes for efficiency of all treatments, globally, were 1.68 (95CI 1.25 to 2.12), 0.45 (0.26 to 0.64), and 0.76 (0.59 to 0.90), respectively. Except usual lid hygiene for mites count, Children's Hospital of Eastern Ontario ointment (CHEO) for both eradication rate and symptoms, and CHEO, 2% metronidazole ointment, and systemic metronidazole for symptoms, all treatments were efficient. Stratified meta-analysis did not show significant differences between local and systemic treatments (1.22, 0.83 to 1.60 vs 2.24, 1.30 to 3.18 for mites count; 0.37, 0.21 to 0.54 vs 0.56, 0.06 to 0.99 for eradication rate; and 0.77, 0.58 to 0.92 vs 0.67, 0.25 to 0.98 for symptoms improvement).ConclusionWe reported the efficiency of the different treatments of Demodex blepharitis. Because of less systemic side effects, local treatments seem promising molecules in the treatment of Demodex blepharitis.

AB - PurposeWe conducted a systematic review and meta-analysis to evaluate the efficacy of different treatment for Demodex blepharitis. Parameters studied were mites count, improvement of symptoms and mites' eradication, stratified on type of treatments and mode of delivery of treatments (local or systemic).MethodThe PubMed, Cochrane Library, Embase, ClinicalTrials.gov, Google scholar and Science Direct databases were searched for studies reporting an efficacy of treatments for Demodex blepharitis.ResultsWe included 19 studies (14 observational and 5 randomized clinical trials), for a total of 934 patients, 1741 eyes, and 13 different treatments. For mites count, eradication rate, and symptoms improvement, meta-analysis included fifteen, fourteen and thirteen studies, respectively. The overall effect sizes for efficiency of all treatments, globally, were 1.68 (95CI 1.25 to 2.12), 0.45 (0.26 to 0.64), and 0.76 (0.59 to 0.90), respectively. Except usual lid hygiene for mites count, Children's Hospital of Eastern Ontario ointment (CHEO) for both eradication rate and symptoms, and CHEO, 2% metronidazole ointment, and systemic metronidazole for symptoms, all treatments were efficient. Stratified meta-analysis did not show significant differences between local and systemic treatments (1.22, 0.83 to 1.60 vs 2.24, 1.30 to 3.18 for mites count; 0.37, 0.21 to 0.54 vs 0.56, 0.06 to 0.99 for eradication rate; and 0.77, 0.58 to 0.92 vs 0.67, 0.25 to 0.98 for symptoms improvement).ConclusionWe reported the efficiency of the different treatments of Demodex blepharitis. Because of less systemic side effects, local treatments seem promising molecules in the treatment of Demodex blepharitis.

KW - Demodex

KW - Blepharitis

KW - Infection

KW - Immunology

KW - Inflammation

KW - Tea tree oil

KW - Ivermectin

KW - Pilocarpine

KW - Metronidazole

U2 - 10.1016/j.jtos.2019.06.004

DO - 10.1016/j.jtos.2019.06.004

M3 - Article

JO - The Ocular Surface

JF - The Ocular Surface

SN - 1542-0124

ER -