If your patient has recurrent chalazia, consider co-occurring Demodex blepharitis
Dagny Zhu, MD, of DZEYEMD, spoke with Ophthalmology 360 about a paper she presented at the 2026 ASCRS Annual Meeting, which found that more than 70% of patients with chalazia also have Demodex blepharitis. She discussed how to diagnose and treat these patients.
Dagny Zhu, MD:
Hi, I’m Dr. Dagny Zhu. I’m a cornea, cataract, refractive surgeon in private practice in Los Angeles, California, and I’m very happy to share with you a presentation that we made at ASCRS in DC this year. It was entitled “Estimating the Prevalence of Demodex Blepharitis in Chalazia Patients.”
This was a very interesting study because we see these patients all the time in our practice: young, healthy patients coming in with chalazia or eyelid inflammation. The question was how many of these patients have coexisting underlying Demodex blepharitis?
This was a retrospective review, multicenter, and we reviewed all charts in which patients had a primary diagnosis of chalazia or hordeola. Then we went and looked through the exam findings to see how many of those patients were also diagnosed with Demodex blepharitis or had the presence of collarettes. We excluded patients that had concurrent acute inflammation or infection, as well as those who were on steroids, because that can also lead to an overprevalence of Demodex.
The findings were very interesting; 71% of all patients with chalazia or hordeola were found to have concurrent Demodex or the presence of collarettes, so that’s a very big number. Of those patients with chalazia, those who had recurrent chalazia, ongoing episodes, actually, 88% of those patients had concurrent Demodex blepharitis or the presence of collarettes.
That really flags us as practitioners to look at our chalazia patients closer for something underlying that may be causing them to have these recurrent cases of hordeola or chalazia. Especially when you think about Demodex, these mites are causing mechanical blockage of the lash follicles, which can lead to hordeola or of the meibomian glands, and that obstruction leads to inflammation and the growth of the chilazia that we see. They also carry Staph bacteria and can induce a lot of inflammation, so it makes sense that we’re seeing a concurrence of both diseases.
This is a nice study to actually point it out that data does show that indeed these patients do have underlying Demodex. In order to appropriately treat the chalazia and hordeola, we can’t just rely on our traditional methods of warm compresses, incision, and drainage, because they have a high chance of it being recurrent. We have to treat the underlying cause, which in this case may be the Demodex itself. You would use prescription lotilaner to actually attack the root problem and to actually kill those mites that are there and growing in overabundance.
A very interesting study, and it’s definitely opened my eyes to how I treat my chalazia patients and what I look for. As a reminder to you who are practicing, always have patients look down so that you can evaluate the base of the eyelashes to make sure that there are or aren’t the presence of collarettes, because again, collarettes equals mite debris, waste, eggs, and so it’s basically pathognomonic for Demodex. If you see collarettes, you should definitely treat, especially for these patients coming in with recurrent chalazia or hordeola.
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