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October 27, 20259 min ReadLast reviewed November 10, 2025

Emerging and Experimental Treatments for Blepharitis

A clear overview of newer and experimental options, how they work, and why availability and evidence can vary.

Clinical eyelid care setup with clean instruments and soft lighting.
D
Dr Awais Rauf
Ophthalmologist, CCT (Ophth) UK
Reviewed by Dr Awais Rauf
Medically Reviewed

This page covers newer or specialist-led options with varying evidence quality and UK availability. The goal is to explain what they are, the evidence to date, and why access can vary.

What "experimental" means in blepharitis care

These options are not first-line care. They may be new, have a smaller evidence base, be used off-label, or be available only in limited settings.

  • Evidence is evolving: Studies may be small or short-term.
  • Availability varies: Some options are not licensed in the UK or are private only.
  • Outcomes can vary: Responses differ by the cause of blepharitis.

Information only: This page does not recommend any treatment. It summarizes emerging options and the current state of evidence.

Quick UK availability snapshot

Availability, classification, and licensing can change. This page summarizes emerging options; check current UK product status and discuss suitability with a clinician.

  • Not currently UK-licensed: Lotilaner 0.25% (Xdemvy), lifitegrast 5% (Xiidra), perfluorohexyloctane prescription drops (Miebo).
  • UK-licensed for other indications: Ciclosporin drops (Ikervis), tacrolimus ointment (Protopic), ivermectin cream (Soolantra).
  • UK products (non-prescription): PFHO lubricants (e.g., EvoTears) for evaporative dry eye symptoms.
  • Procedures: Meibomian gland probing and radiofrequency eyelid heating may be offered in selected private clinics.

1) Demodex-targeted options

Demodex mites can drive lid-margin inflammation. The key clinical sign is collarettes (cylindrical dandruff) around the lashes.

Lotilaner ophthalmic solution 0.25% (Xdemvy)

A prescription eye drop designed to kill Demodex mites. Phase 3 trial data showed improvements in collarettes and lid redness after a 6-week course.

UK status: FDA-approved in the US. Not currently licensed in the UK.

Topical ivermectin (off-label on eyelid skin)

Ivermectin cream is licensed for skin rosacea. Small studies suggest it may reduce Demodex burden when used on eyelid skin, but it is not licensed for the ocular surface.

2) Immune-modulating drops and ointments

In some people, inflammation is a major driver. These treatments aim to calm the immune response rather than remove debris.

Ciclosporin eye drops (Ikervis)

Licensed in the UK for severe dry eye keratitis. Studies in MGD populations suggest improvements in tear stability and symptoms in selected patients.

Lifitegrast 5% (Xiidra)

An anti-inflammatory drop with evidence in inflammatory MGD. It is not authorized in the EU and is not routinely available in UK practice.

Tacrolimus 0.03% ointment (Protopic)

A skin immunomodulator licensed for atopic dermatitis. Small studies describe use on eyelid skin in refractory blepharitis, but evidence is limited.

3) Evaporation-barrier / lipid-layer support

These products aim to reduce tear evaporation in MGD-related dry eye.

Perfluorohexyloctane (PFHO)

PFHO has shown meaningful improvements in dry eye associated with MGD. PFHO is available in different forms depending on country and product classification. Availability and licensing can change. Check current UK product status and ask a clinician/pharmacist if unsure.

4) Specialist procedures still considered emerging

Intraductal meibomian gland probing (MGP)

A fine probe opens blocked meibomian gland ducts. Some controlled trials suggest benefit for certain outcomes, but results are mixed and larger studies are needed.

Radiofrequency (RF) eyelid heating

RF devices apply controlled heat, sometimes combined with gland expression. Evidence is growing but protocols vary and long-term data is limited.

5) Complementary options with early evidence

Medical-grade Manuka honey eyelid products

Some studies suggest potential symptom improvement with eye-specific Manuka honey products, but stinging is common and evidence is still limited; suitability varies.

How to use this information

This overview is designed to explain newer terms you may see online or in clinic literature. Evidence ranges from early to moderate and availability differs across the UK.

Explore next

Related content

Continue with related guides that build on this topic and keep your care plan consistent.

01

Medical treatments guide

When blepharitis treatment needs prescriptions.

02

Daily hygiene routine

Warm compresses, massage, and lid cleansing basics.

03

All treatment options

Compare in-office procedures for MGD.

04

Thermal pulsation

Heat-and-pressure treatment for blocked glands.

Quick answers

FAQs

Short, practical answers to common questions patients ask.

Evidence-led guidance, written for patients.
Expand any question to see the full answer.
Are experimental treatments available on the NHS?
Availability varies and many options are not licensed in the UK. Your GP or specialist can advise on local pathways.
Should I try experimental treatments before standard care?
No. First-line care includes lid hygiene and established therapies; emerging options are usually considered later.
Are these treatments safe?
Safety and evidence levels vary. A specialist should review risks and benefits for your specific case.
Is anything UK licensed for Demodex blepharitis?
Some products are licensed for related conditions, but many Demodex-specific drops are not yet UK licensed.

Scientific References

  1. U.S. Food and Drug Administration (FDA). Lotilaner ophthalmic solution 0.25% (Xdemvy) label documents. 2023.
  2. Gaddie IB, Donnenfeld ED, Karpecki P, et al. Lotilaner Ophthalmic Solution 0.25% for Demodex Blepharitis: Phase 3 Trial (Saturn-2). Ophthalmology. 2023;130(10):1015-1023.
  3. Syed YY. Lotilaner ophthalmic solution 0.25%: first approval. Drugs. 2023.
  4. European Medicines Agency (EMA). Xiidra (lifitegrast): EPAR (withdrawn/ended procedure).
  5. NICE. Lifitegrast for treating dry eye disease (ID1229) - project status: discontinued.
  6. Tauber J. Lifitegrast 5% vs thermal pulsation for inflammatory MGD. Cornea. 2020;39(4):403-407.
  7. Bausch + Lomb / Novaliq. FDA approval announcement for Miebo (perfluorohexyloctane ophthalmic solution). 2023.
  8. Tauber J, et al. NOV03 (perfluorohexyloctane) for dry eye disease associated with MGD. Ophthalmology. 2023.
  9. UK eMC. Ikervis 1 mg/mL eye drops, emulsion - SmPC.
  10. Prabhasawat P, Tesavibul N, Mahawong W. 0.05% cyclosporine ophthalmic emulsion for MGD. Cornea. 2012;31(12):1386-1393.
  11. Rhim JW, et al. 0.05% cyclosporine nanoemulsion in obstructive MGD. Cornea. 2022.
  12. UK eMC. Protopic 0.03% ointment - SmPC (tacrolimus).
  13. Sakassegawa-Naves FE, et al. Tacrolimus ointment for refractory posterior blepharitis. Curr Eye Res. 2017;42(11):1440-1444.
  14. UK eMC. Soolantra 10 mg/g cream - SmPC (ivermectin).
  15. Kheirkhah A, et al. Randomised, sham-controlled trial of intraductal meibomian gland probing. Ocul Surf. 2020;18(4):852-856.
  16. Chelnis J, et al. Multi-frequency radiofrequency combined with IPL/MGX for MGD. 2023.
  17. Craig JP, Cruzat A, Cheung IMY, et al. Manuka honey microemulsion eye cream for blepharitis. Ocul Surf. 2020;18(1):170-177.