A Delphi approach to establishing consensus on best practice for the diagnosis and treatment of Demodex blepharitis

Nikhil Sharma*, Eilidh Martin, Edward Ian Pearce, Suzanne Hagan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Demodex blepharitis does not have agreed standardized guidelines. The aim of this study was to classify signs and symptoms and to develop appropriate management strategies for Demodex blepharitis from a consensus of expert advice. 

Methods: A total of 11 anterior segment experts (ophthalmologists, optometrists and a contact lens optician) working in the United Kingdom participated in a modified 2-round Delphi panel. A mixed-methods approach was adopted and a survey questionnaire for round 1 was formulated, constructed from information in the available literature. Based on panel responses from round 1, feedback was provided and a round 2 questionnaire was formulated. More than two-thirds majority (72%) was used for consensus building. 

Results: Based on the clinical presentation of signs and symptoms along with associated conditions and risk factors, a diagnostic algorithm was proposed for the clinical investigation of Demodex blepharitis. A treatment algorithm was also proposed with first-line and second-line treatment recommendations for Demodex blepharitis. 

Conclusion: The recommendation from this study provides the first effort in formulating clinical diagnostic algorithm and management guidelines for Demodex blepharitis. The guidelines include appropriate magnification on the slit lamp, associated signs, symptoms, risk factors and suggested management options. These guidelines can be used in a routine eyecare setting to encourage eyecare practitioners in tailoring the investigation and management of Demodex blepharitis.

Original languageEnglish
Article number102080
Number of pages10
JournalContact Lens and Anterior Eye
Issue number1
Early online date8 Nov 2023
Publication statusPublished - Feb 2024


  • consensus
  • Delphi panel
  • demodex blepharitis
  • dry eye
  • ocular surface

ASJC Scopus subject areas

  • Ophthalmology
  • Optometry


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