Topical Ivermectin-metronidazole gel therapy improves Meibomian gland Function in blepharitis caused by demodex spp

Purpose: To evaluate the efficacy and safety of topical Ivermectin- Metronidazol in the management of demodex infestation and their effect in Meibomian gland dysfunction (MGD) METHODS: Fifty-four patients (108 eyes) with demodex diagnosis and Meibomian gland dysfunction received Ivermectin 0.3 %+Metronidazole 0.5 % gel in the night for 5 weeks. Parameters were evaluated before and 8 weeks after the last application of IVM-MTZ. This includes demodex counts, OSDI tests, non-invasive breakup time (NIBUT), average noninvasive breakup time (AvNIBUT), and infrared meibography with the determination of glandular dropout.

Results: A complete eradication of infestation was observed with the proposed treatment. A significant improvement in NIBUT, AvNIBUT, and OSDI score. The Meibomian gland improved with the treatment with a reduction of the glandular dropout from 50 ± 1.4 % to 39.05 ± 1.2 % (P < 0.0005) CONCLUSIONS: Management of demodex infestation in MGD improves tear film parameters, reduces ocular symptoms, and induces improvement in the anatomy of Meibomian glands. This is the first intervention that induces anatomical changes in Meibomian glands and must be considered as a modality for the treatment of MGD-demodex coexistence.