Emerging and Experimental Treatments for Blepharitis

This page covers treatments described as emerging or experimental in blepharitis care. 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.

Quick UK availability snapshot

• 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. In the US it is a prescription medicine (Miebo). In the UK, PFHO is available as lubricant products such as EvoTears.

4) Specialist procedures still considered emerging

Intraductal meibomian gland probing (MGP)

A fine probe opens blocked meibomian gland ducts. A sham-controlled trial showed symptom improvement in some groups, but 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

Eye-specific Manuka honey formulations have shown symptom improvements in a masked trial. Stinging can occur, and product choice matters.

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.

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