Treatment Effects Of Lotilaner Ophthalmic Solution 0.25% And Tea Tree Oil For Demodex Blepharitis: A Systematic Review And Meta-Analysis
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR517 | Type: Free paper | DOI: 10.82333/treq-9f17
Authors: Prof. Mayank Nanavaty* 1 , Dr Darrell White 2 , Dr Timothy Page 3 , Ms Noemi Brennan 4 , Dr Elizabeth Yeu 5 , Prof. Burkhard Dick 6
1Sussex Eye Hospital,University Hospitals Sussex NHS Foundation Trust,Brighton,United Kingdom, 2Ophthalmology,Sky Vision Centers,Westlake,United States, 3Ophthalmology,Oakland University William Beaumont School of Medicine,Rochester,United States, 4Ophthalmology,Curta, Inc,Seattle,United States, 5Ophthalmology,Tarsus Pharmaceuticals, Inc.,Irvine,United States, 6Ophthalmology,University of Bochum Eye Clinic, ,Bochum,Germany
Purpose
Demodex blepharitis is an inflammatory disease of the eyelids caused by an infestation of Demodex mites. This affects approximately 54%, 58% and up to 67% of patients visiting eye care clinics in Europe, United States and Japan, respectively. This systematic review and meta-analysis aimed to estimate treatment effects for lotilaner ophthalmic solution 0.25% versus vehicle and tea tree oil (TTO) versus sham for Demodex blepharitis.
Setting
Randomized controlled trials (RCTs) evaluating adult patients with Demodex blepharitis.
Methods
The current systematic review and meta-analysis study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE, EMBASE, Cochrane CENTRAL, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) to identify RCTs evaluating lotilaner 0.25% versus vehicle or tea tree oil (TTO) products versus sham in adults with Demodex blepharitis. English-language studies from database inception through July 2025 were eligible for inclusion. All studies included in the meta-analysis reported outcomes for mite density reduction and mite eradication, and trials evaluating lotilaner additionally reported collarette reduction to 0-2 collarettes.
Results
Nine RCTs were included. Patients treated with lotilaner 0.25% had significantly greater odds of achieving collarette reduction to 0–2 collarettes than vehicle at 2–4 weeks (OR=8.39) and 6–8 weeks (OR=9.67) (all p<0.001). Lotilaner 0.25% also significantly improved mite density and eradication, with a pooled mean difference of −1.29 mites/lash versus vehicle at both 2–4 and 6–8 weeks and higher odds of eradication at 2–4 weeks (OR=4.70) and 6–8 weeks (OR=9.60) (all p<0.0001). In contrast, TTO showed no significant difference versus sham: pooled mean differences of −0.02 mites/lash (p=0.747) at 2–4 weeks and −0.00 mites/lash (p=0.651) at 6–8 weeks, and odds ratios for eradication of 1.81 (p=0.274) and 1.47 (p=0.722) at the same time points.
Conclusions
Lotilaner 0.25% demonstrated statistically significantly better mite density reduction and mite eradication versus vehicle, while TTO products showed no benefit over sham. These findings highlight the important therapeutic role of lotilaner 0.25% in the management of Demodex blepharitis.