Topical ivermectin 1.0% cream in the treatment of ocular demodicosis


Purpose Ocular demodicosis can cause debilitating ocular surface disease. As ivermectin is effective at reducing Demodex proliferation in rosacea, this study investigated the efficacy of topical ivermectin 1.0% cream in treating ocular demodicosis. Methods This retrospective single-centre clinical practice chart analysis involved the off-label treatment of patients who had ocular demodicosis with topical ivermectin 1.0 % cream (Soolantra, Galderma Ltd, UK) applied nightly to the lid margins of both eyes for 3 months. Ocular surface health was assessed at baseline when the treatment was prescribed and followed up at 3 and 12 months after baseline. Slit lamp biomicroscopy was used to take digital images of the upper eyelid lashes. Manual image analysis with ImageJ was conducted by a masked assessor to quantify signs of ocular demodicosis including the number of lashes with collarettes, with visible Demodex tails and with follicle pouting. Results Data from a total of 75 patients with ocular demodicosis were analysed for this study (mean age 66.6 ± 13.9 years, 44 female). The numbers of lashes with collarettes (Median [Interquartile range]: 8 [4–13] at baseline to 0 [0–2] at the final visit, p < 0.001) and lashes with follicle pouting (3 [1–5] at baseline to 0 [0–1.8] at the final visit, p < 0.001) decreased with treatment. Any sign of lashes with visible tails was eliminated by the final visit (p < 0.007). Fluorescein staining severity score also improved, particularly from baseline (1 [0–2]) to the second visit (0 [0–1], p < 0.001). Conclusions The findings of this study show evidence for the efficacy of a 3-month course of topical ivermectin 1.0% cream in treating ocular demodicosis as indicated by reduction in collarettes, follicle pouting and visible Demodex tails. More research is warranted to improve the diagnosis, management and monitoring of this condition which is often overlooked or misdiagnosed.

Publication DOI:
Divisions: College of Health & Life Sciences > School of Optometry > Optometry & Vision Science Research Group (OVSRG)
College of Health & Life Sciences
College of Health & Life Sciences > School of Optometry > Optometry
College of Health & Life Sciences > School of Optometry
Additional Information: © 2023 The Author(s). Published by Elsevier Ltd on behalf of British Contact Lens Association. This is an open access article under the CC BY license (
Uncontrolled Keywords: Antiparasitic agents,Blepharitis,Demodex,Eyelashes,Eyelids,Ivermectin,Ophthalmology,Optometry
Publication ISSN: 1476-5411
Last Modified: 05 Jul 2024 16:23
Date Deposited: 04 Dec 2023 11:11
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Related URLs: https://www.sci ... 3405?via%3Dihub (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2023-12-03
Published Online Date: 2023-12-03
Accepted Date: 2023-11-27
Authors: Smith, Martin
Wolffsohn, James s. (ORCID Profile 0000-0003-4673-8927)
Chiang, Jeremy chung bo (ORCID Profile 0000-0002-6133-7411)



Version: Published Version

License: Creative Commons Attribution

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