Association Of Demodex Infestation With Meibomian Gland Disease: A Systematic Review Of Evidence
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR457 | Type: Free paper | DOI: 10.82333/g2vm-wh02
Authors: A/Prof. Oliver Findl** 1 , Dr Mark Pyfer 2 , Dr Zaina Al-Mohtaseb 3 , Dr Nicole Fram 4 , Dr Lisa Bloudek 5 , Dr Kendall Donaldson 6 , Dr Elizabeth Yeu 7 , Dr Ruth Lapid-Gortzak 8
1Ophthalmology, Hanusch Hospital,Vienna,Austria, 2Northern Ophthalmic Associates,Jenkintown, PA ,United States, 3Whitsett Vision Group,Houston, TX ,United States, 4Advanced Vision Care,Los Angeles, CA ,United States, 5Curta, Inc,Seattle, WA ,United States, 6Bascom Palmer in Plantation,Plantation, FL ,United States, 7Tarsus Pharmaceuticals,Irvine, CA ,United States, 8Ophthalmology,Amsterdam University Medical Centres,Amsterdam,Netherlands
Purpose
Demodex blepharitis (DB) is an inflammatory eyelid disease resulting from infestation by Demodex mites. Increasing evidence suggests that DB is associated with meibomian gland disease (MGD) and may contribute to its onset and progression. The objective of this systematic review is to comprehensively evaluate the existing evidence on the association between Demodex infestation and MGD-related outcomes to better clarify the potential role of Demodex in the pathogenesis of MGD.
Setting
Observational or chart review studies of patients evaluated for DB and MGD in ophthalmology or optometry clinics.
Methods
A comprehensive systematic search of PubMed and Embase was performed from database inception, without time restrictions, through January 6, 2026, to identify studies reporting MGD-related outcomes. Eligible studies evaluated the prevalence of MGD or MGD-related objective measures stratified by the presence or absence of Demodex infestation. Outcomes of interest included meibum quality, meibomian gland dropout, meibomian gland atrophy, and lid margin abnormalities. Other parameters, including corneal fluorescein staining (CFS) and tear breakup time (TBUT), were also extracted. Interventional studies were excluded from the analysis.
Results
Out of 521 records, 23 studies involving patients with DB and MGD met the eligibility criteria and were included. The prevalence of MGD was higher in patients with Demodex infestation (44%-99%) than in those without Demodex (0%-18%). Conversely, the reported Demodex rates ranged from 45%-89% in patients with MGD, compared to 13%-44% in patients without MGD. Patients with Demodex infestation showed statistically significantly worse MGD-related outcomes, including lower meibum quality, increased meibomian gland dropout and atrophy, and higher lid margin abnormality scores compared to those without Demodex. Patients with Demodex infestation also demonstrated higher CFS scores and shorter TBUT than those without Demodex.
Conclusions
Demodex infestation was associated with worse MGD-related outcomes. This finding suggests that Demodex infestation may play a role in the development and progression of MGD and highlights the importance of routinely assessing for both conditions to optimize patient management.