Orion Registry Reveals Burden of Demodex Blepharitis, With Kendall E. Donaldson, MD

Interim results from the ongoing Orion registry are shedding new light on the significant impact of Demodex blepharitis (DB) on patients and the potential of targeted therapy to improve symptoms.

Presented at the 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting by Kendall Donaldson, MD, a professor of clinical ophthalmology at the Bascom Palmer Eye Institute, the study captures real-world outcomes from patients tracked over 12 months across 20 US eyecare centers.

“We know from prior studies, such as the Titan study, that about 58% of patients who come through our clinics have Demodex Blepharitis,” Donaldson told HCPLive. “We also know that 99% of those patients are symptomatic to some degree, so the Orion study was designed to follow Demodex patients through their experience and categorize their symptoms and response to treatment.”

The Orion registry enrolled 447 patients from 20 U.S. eyecare sites, collecting longitudinal data on symptoms, treatment use, and functional impact. Among 300 patients analyzed, at baseline, 91% reported symptoms of Demodex blepharitis.

Most patients (68%) were using at least one over-the-counter treatment, most commonly tea tree eyelid cleansers (32%), artificial tears (27%), and warm compresses (25%). Prescription therapies were used by 41%, with lotilaner ophthalmic solution, 0.25% (Xdemvy) being the most common (30%).

Donaldson highlighted the symptom burden in the cohort, pointing out that 89% of patients had at least one symptom from Demodex blepharitis, and nearly 84% of patients had at least three symptoms. Among those who completed a one-month follow-up, patients treated with lotilaner experienced significant improvement in both symptoms, such as itchy eyelids and crusted lashes, and daily functioning compared to those not on the medication.

A measurable benefit was identified from treatment with lotilaner ophthalmic solution, as the visual analog scale improved significantly over 6 months.

“These are preliminary data and so we're very excited to collect more data over the upcoming months,” Donaldson told HCPLive.

Donaldson reports relevant disclosures with AbbVie, Alcon, Bausch and Lomb, Dompe, Tarsus, and others.

References

1. Donaldson KE, Rapoport Y, Edell AR, et al. Longitudinal Evaluation of Disease Burden and Treatment Efficacy in Patients with Demodex blepharitis: Orion Registry Interim Results. Paper presented at the 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting. April 25-28, 2025. Los Angeles, CA.

2. Trattler W, Karpecki P, Rapoport Y, et al. The Prevalence of Demodex Blepharitis in US Eye Care Clinic Patients as Determined by Collarettes: A Pathognomonic Sign. Clin Ophthalmol. 2022;16:1153-1164. Published 2022 Apr 15. doi:10.2147/OPTH.S354692