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Contact Lens Dropout? Start With the Lids

Demodex and MGD may be the culprit.

By: Pamela E. Theriot, OD
Optometric Management September 1, 2026 Vol 61, Issue September-October 2026 Page(s): 30

Clinical Report: Contact Lens Dropout? Start With the Lids

Overview

Demodex mites and meibomian gland dysfunction (MGD) are significant contributors to contact lens dropout. Effective treatments, including lotilaner 0.25% ophthalmic solution, can address these underlying issues.

Background

Contact lens intolerance is a common challenge in clinical practice, often leading to dropout among wearers. Identifying the underlying causes, such as Demodex infestation and MGD, is crucial for effective management.

Data Highlights

No numerical data provided in the source material.

Key Findings

  • 93% of soft contact lens dropout patients have Demodex mite infestation.
  • Less than 6% of patients with Demodex on their lid margins report no discomfort with contact lens wear.
  • 57% of patients with MGD also have Demodex blepharitis.
  • Lotilaner 0.25% is the only FDA-approved treatment for Demodex blepharitis, effective in eradicating mites within 6 weeks.
  • Clinical trials show a 54% increase in meibomian glands yielding liquid secretions after treatment with lotilaner.
  • Ivermectin 1% cream is an alternative treatment that improves symptoms of Demodex blepharitis.

Clinical Implications

Eye care providers should consider evaluating patients for Demodex infestation and MGD when addressing contact lens dropout.

Conclusion

Addressing the underlying causes of contact lens intolerance, such as Demodex and MGD, is essential.

Related Resources & Content

  1. Markoulli OM, Kolanu S, Clin Optom, 2017 -- Contact lens wear and dry eyes: challenges and solutions
  2. Tarkowski W, Moneta-Wielgoś J, Młocicki D, Biomed Res Int, 2015 -- Demodex sp. as a potential cause of the abandonment of soft contact lenses
  3. Pucker AD, Jones-Jordan LA, Marx S, et al., Cont Lens Anterior Eye, 2019 -- Clinical factors associated with contact lens dropout
  4. Trattler W, Karpecki P, Rapoport Y, et al., Clin Ophthalmol, 2022 -- The prevalence of Demodex blepharitis in US eye care clinic patients
  5. Gaddie IB, Donnenfeld ED, Karpecki P, et al., Ophthalmology, 2023 -- Lotilaner ophthalmic solution 0.25% for Demodex blepharitis
  6. optometric management — Deterring contact lens dropout
  7. contact lens spectrum — CONTACT LENS HANDLING
  8. optometric management — The Presbyopic Contact Lens Dropout Crisis
  9. contact lens spectrum — CONTACT LENS DROPOUT: BLAME THE SURFACE, NOT THE LENS
  10. Deterring contact lens dropout
  11. CONTACT LENS HANDLING
  12. The Presbyopic Contact Lens Dropout Crisis
  13. Lotilaner - EyeWiki
  14. The Demodex Expert Panel on Treatment and Eyelid Health (DEPTH) Consensus Regarding the Preferred Treatment for Demodex Blepharitis - PMC
  15. Cochrane corner: lubricating drops for contact lens discomfort in adults | Eye