Topical ivermectin 1.0% cream in the treatment of ocular demodicosis

Martin Smith, James s. Wolffsohn, Jeremy chung bo Chiang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

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.

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).

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.
Original languageEnglish
Article number102099
JournalContact Lens and Anterior Eye
Early online date3 Dec 2023
Publication statusE-pub ahead of print - 3 Dec 2023

Bibliographical note

© 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


  • Antiparasitic agents
  • Blepharitis
  • Demodex
  • Eyelashes
  • Eyelids
  • Ivermectin


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