Ivermectin in the Management of Demodex-associated Blepharitis: A Comprehensive Literature Review

OBJECTIVES: To review the role of Demodex infestation in blepharitis and summarize available evidence on the efficacy and safety of topical and oral ivermectin. METHODS: This narrative review was conducted through collaboration between expert ophthalmologists and infectious diseases specialists with clinical experience in the use of ivermectin. A literature search was performed in PubMed and Embase from inception to November 2025. RESULTS: Evidence from clinical trials, observational studies, and case series was reviewed and synthesized. Ivermectin, administered orally or topically, has been investigated as a potential treatment option for Demodex-associated blepharitis, either as monotherapy or in combination with other therapies. Across different treatment protocols and patient populations, ivermectin use was generally associated with reductions in Demodex mite density, improvement in cylindrical dandruff, ocular surface parameters, and patient-reported symptoms. Reported adverse events were infrequent and predominantly mild. CONCLUSIONS: Current evidence suggests that ivermectin may represent an effective and overall safe therapeutic option for Demodex-associated blepharitis. Further studies are needed to establish standardized treatment regimens and to assess long-term outcomes.