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  • Oculoplastics/Orbit

    A systematic review and meta-analysis assessed the efficacy and safety of lotilaner ophthalmic solution 0.25% for the treatment of Demodex blepharitis.

    Study Design

    Four randomized clinical trials (RCTs) and 2 observational studies of lotilaner ophthalmic solution 0.25% published before August 2023 met inclusion criteria for the systematic review; the 4 RCTs were included in the meta-analysis.


    Results from the meta-analysis showed that significantly greater reductions in Demodex mite density and mean collarette scores were seen with lotilaner compared with placebo. The pooled outcomes were rated as moderate-quality evidence by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Most adverse events reported for lotilaner treatment were mild; the most common adverse events included burning, redness, blurriness, and ocular discharge.


    There was a variability in both intervention and follow-up durations among the studies. Additionally, many of the studies had relatively small sample sizes and had predominantly female patient populations.

    Clinical Significance

    I will consider lotilaner for patients suffering from Demodex blepharitis with significant collarettes who have already tried conservative therapies of warm compresses and lid hygiene. However, insurance coverage will play a large role in the implementation of this treatment.

    Financial Disclosures: Dr. Anne Barmettler discloses no financial relationships.