Demodex blepharitis is a common ophthalmologic disease that is often overlooked in the workup of blepharitis. Demodex infestation occurs in both symptomatic and asymptomatic individuals at similar rates; consequently, its role in the development of blepharitis has not been well elucidated. Two species have been confirmed to inhabit the human eyelid—Demodex folliculorum and Demodex brevis. These species differ in their preferred location of infestation, with D. folliculorum occupying the base of the eyelash and D. brevis inhabiting the meibomian glands, contributing to anterior and posterior Demodex blepharitis, respectively. A clinical index of suspicion must be developed from the history when blepharitis, conjunctivitis, or keratitis in adults and blepharoconjunctivitis or chalazia in children are resistant to treatment. The diagnosis can be strongly suspected by the presence of cylindrical dandruff at the base of the eyelash and confirmed by light microscopy of an epilated lash or by in vivo confocal microscopy. No cure is currently available. Management most frequently includes topical tea tree oil and its active ingredient terpinen-4-ol, both of which have produced good clinical outcomes. Topical tea tree oil is typically applied by a professional due to risk of toxicity. Several second-line treatment options have been studied, including ivermectin, metronidazole, selenium sulfide, microblepharoexfoliation, and lid hygiene. Novel, targeted therapies such as TP-03 (Tarsus Pharmaceuticals) are also currently being investigated in phase 2b/3 clinical trials. The purpose of this review purpose is to characterize Demodex blepharitis in detail, including its historical perspective and various classifications, and describe the latest diagnostic and management strategies.

蠕形螨性睑缘炎是一种常见的眼科疾病，在睑缘炎的检查中常常被忽视。蠕形螨感染在有症状和无症状个体中的发生率相似；因此，它在睑缘炎发展中的作用尚未得到很好的阐明。已证实有两种物种栖息在人类眼睑上——毛囊蠕形螨和短蠕形螨。这些物种的首选感染位置不同，D. folliculorum占据睫毛根部，而D. brevis栖息于睑板腺，分别导致前部和后部蠕形螨睑缘炎。当成人的睑缘炎、结膜炎或角膜炎以及儿童的睑缘结膜炎或霰粒肿对治疗有抵抗力时，必须从病史中得出临床怀疑指标。睫毛根部存在圆柱形头皮屑可强烈怀疑该诊断，并通过脱毛睫毛的光学显微镜或体内共聚焦显微镜证实。目前没有治愈方法。管理最常包括外用茶树油及其活性成分 terpinen-4-ol，两者都产生了良好的临床效果。由于毒性风险，外用茶树油通常由专业人员使用。已经研究了几种二线治疗方案，包括伊维菌素、甲硝唑、硫化硒、微眼睑去角质和眼睑卫生。TP-03（Tarsus Pharmaceuticals）等新型靶向疗法目前也在2b/3期临床试验中进行研究。本综述的目的是详细描述蠕形螨性睑缘炎的特征，包括其历史观点和各种分类，并描述最新的诊断和管理策略。