Permethrin Cream for the Treatment of Demodex Blepharitis

Purpose: To evaluate the safety and efficacy of permethrin 5% cream for the treatment of Demodex blepharitis. Methods: Patients with confirmed Demodex blepharitis were prospectively recruited and treated with permethrin 5% cream for 6 months. Blepharitis symptoms, ocular examination findings, ocular surface disease index, and ex vivo eyelash Demodex counts were regularly assessed. Results: Twenty-three patients were recruited, of which 2 were lost to follow up and 21 entered the analysis. Mean patient age was 57.2 ± 16.8 years (range: 24–82 years), and 13 (62%) were women. Mean Demodex counts improved after treatment from 1.36 ± 1.233 to 0.48 ± 0.6 parasites per eyelash (P = 0.03), and the overall blepharitis symptoms score improved from 42.9 ± 22 to 32.7 ± 21 (P = 0.01). Improvement in disease symptoms (scored on a scale between 0 and 4) was noted including feeling of dry eye (2.85 ± 1.3–1.85 ± 1.7, P = 0.006), discharge (1.86 ± 1.7–1.00 ± 1.1, P = 0.040), and dandruff-like debris (1.69 ± 1.7–0.9 ± 1.6, P = 0.033), as well as clinical findings including a decrease in scaling (on a scale of 1–5; 1.43 ± 0.9–0.86 ± 0.7, P = 0.006) and corneal staining with fluorescein (on a scale of 1–4; 1.29 ± 0.4–1.05 ± 0.2, P = 0.040). No change in the ocular surface disease index score was noted (37.5 ± 24.1–41.63 ± 42.5, P = 0.913), and no adverse events were reported. Conclusions: Treatment of Demodex blepharitis with permethrin 5% cream resulted in a decrease in parasite burden and improvement in blepharitis signs and symptoms, with no reported adverse events. Permethrin might be a safe and effective alternative for the treatment of blepharitis associated with Demodex infection.