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Collarettes are a pathognomonic sign of Demodex infestation.

Demodex Blepharitis

Signs
Collarettes
Eyelash disorders
Crusting and redness of the lid margin
Inflammation of the lid margin, conjuctiva, and cornea

Symptoms
Itching
Burning
Foreign body sensation
Blurry vision

100% of Lashes with Collarettes Have Demodex

  • Gao 2005 study confirmed that Demodex mites were found on 100% of lashes
    with collarettes

  • Of lashes without collarettes, those using lid scrubs due to a previous diagnosis of blepharitis or meibomian gland disease (MGD) had 50% of lashes with Demodex, while those without had only 7%

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Demodex Blepharitis can be diagnosed when collarettes, a pathognomonic sign of Demodex infestation, are seen with a routine slit-lamp exam. 

As mites scratch and feed on the skin, the partially digested epithelial cells, keratin, mite waste and eggs combine to form collarettes. These collarettes are typically found at the base of the lash but can migrate up as the hair shaft grows.  Collarettes can range in size and number, but all are a result of Demodex infestation.

 

Scroll to see examples of varying degrees of collarettes

 
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Currently, there are 2.1M blepharitis diagnoses per year, but no FDA approved treatments.

If left unmanaged, Demodex Blepharitis may lead to tear film instability with fluctuating and blurred vision, lid and lash abnormalities, inflammation of the conjunctiva and surrounding skin, suboptimal surgical outcomes, contact lens intolerance and reduced wear time, noticeable eye and eyelid redness, and lower patient quality of life.

Sources
1. American Academy of Ophthalmology Cornea/External Disease Panel. Preferred Practice Panel Guidelines: Blepharitis. San Francisco, California: American Academy of Ophthalmology; 2013. www.aao.org/ppp. 2. Lemp et al. Blepharitis in the United States 2009: A Survey-based Perspective on Prevalence and Disease. The Ocular Surface, May 2009. 3. Harmon, Market Scope Dry Eye Analyst Report, 2014 4. MGD Report IOVS, Special Issue 2011, Vol. 52, N. 4 5. Zhao YE, Wu LP, Hu L, Xu JR. Association of blepharitis with Demodex: a meta-analysis. Ophthalmic Epidemiol 2012;18=9:95-102. 6. English FP. Demodex folliculorum and oedema of the eyelash. Br J Ophthalmol. 1971;55(11):742-746. doi:10.1136/bjo.55.11.742 7. Rufli T, Mumcuoglu Y. The hair follicle mites Demodex folliculorum and Demodex brevis: biology and medical importance. A review. Dermatologica. 1981;162(1):1-11. 8. Desch C.E., Channabasavanna G.P. and Viraktamath C.A. 1989. Progress in Acarology. Brill Archive. Pgs 187-188. 9. Coston TO. Demodex folliculorum blepharitis. Trans Am Ophthalmol Soc. 1967;65:361-392.10. Fromstein. Demodex blepharitis: clinical perspectives. Clinical Optometry. 2018 11. Nicholls SG, Oakley CL, Tan A, Vote BJ. Demodex species in human ocular disease: new clinicopathological aspects. Int Ophthalmol. 2017;37(1):303–312. 12. Gao Y-Y, Di Pascuale MA, Li W, et al. High Prevalence of Demodex in Eyelashes with Cylindrical Dandruff. Investig Opthalmology Vis Sci. 2005;46(9):3089. doi:10.1167/iovs.05-0275 13. American Optometric Association. Glossary of Common Eye and Vision Conditions. Accessed April 2020. 14. Primary Care Optometry News. Treat Blepharitis Preoperatively for Optimal Cataract Surgery Results. November/December 2010. 15. Symphony Claims data 2018-2019