08/09/2026
Demodex blepharitis is a common eyelid condition caused by an overgrowth of microscopic Demodex mites living in hair follicles and oil glands.
Symptoms include:
- red, irritated eyelids
- itchy eyes
- sticky eyelids
- foreign body sensation, gritty feeling
- burning or stinging eyes
- excessive tearing
- thinning or falling out eyelashes
Treatment:
- Eyelid hygiene with wipes, cleanser, hypochlorous acid spray.
- Lotilaner Ophthalmic Solution 0.25% (Xdemvy)
- Artificial tears for dryness
Botox is commonly used for wrinkle prevention.
But when injected into the orbicularis oculi (the muscle surrounding the eye), it can weaken or inhibit the ability to fully close the eye.
If too much Botox spreads or is placed incorrectly near the lower or upper eyelid, it can impair the blink reflex, leading to incomplete eye closure, exposure, or dry eyes (lagophthalmos).
The good news is this effect is temporary and should wear off gradually in 3 to 4 months.
For this patient, I started treatment with artificial tears, nighttime ointment, and topical steroids. She was also encouraged to focus on complete blinks during the day, and take breaks every 20 minutes from focused tasks to encourage blinking. We’ll see how her cornea looks at follow up and modify treatment accordingly.
Conjunctival prolapse can be seen with scleral lens wear. Older patients with more conjunctival laxity are more prone to it. If a patient is asymptomatic and there’s no complications, this is okay to monitor. However, if there’s associated discomfort or redness, it should be addressed.
With scleral lenses, prolapse can occur from negative pressure creating suction under a tight or poorly fit contact lens. It’s can also occur from inserting lenses with too much force, resulting in suction. The suction pulls loose tissue underneath the lens. Watching how a patient inserts their lenses and educating them on gentle insertion can be helpful if that is the cause of suction.
If the cause of prolapse is due to excessive limbal vault or tight haptics, adjusting the fit of the contact lens by reducing the fluid vault or changing the edge alignment can help eliminate the suction.
Corneal gas pe
