The following article was written by Eric Schmid. Feel free to leave your thoughts in the comments below.
This topic was also covered by Rosacea News in 2018 – Soolantra for Ocular Rosacea
Is Soolantra, spread on eye lids, a good therapy for dry eye, blepharitis, or ocular rosacea?
There is a well-known therapy for cutaneous rosacea with a 1% ivermectin cream called Soolantra. Some people report excellent results. The question is whether this therapy could be extended to ocular rosacea, blepharitis, and dry eye. Unfortunately, the instructions for use of Soolantra say: “Make sure to avoid the eye lids, …”. What about trying an off-label therapy by spreading Soolantra on the eye lids?
In fact, there is a publication in a scientific journal suggesting exactly that. In the abstract of the paper, as well as in the conclusion, it is stated that this therapy is “safe and effective”.
In our discussion forum we should discuss that; the exact reference of the publication is given below (1). To start the discussion, let us put down the pros and contras.
Arguments for trying the indicated off-label use of Soolantra:
It would be wonderful to find a new therapy for dry eye, blepharitis, or ocular rosacea.
Side effects could eventually be cured by treatments that are common in ophthalmology.
Arguments against trying the indicated off-label use of Soolantra:
The recommendation given in the publication is based on results obtained from only 10 retrospectively selected patients. These patients did not show any adverse side effects. The number of 10 patients is too small to guarantee that the therapy is “safe and effective”.
There is one more patient who has been treated with Soolantra spread on the eye lids. This patient showed a severe side effect. This patient has been 85 years old at the time of the treatment. He had several risk factors like glaucoma treatment and several eye operations. He spread Soolantra on the eye lids twice daily.
Let us return to something more positive. In case of the 85-year-old patient it took 5 months of treatment before the severe side effect showed up. This is an indication that an eventual toxic effect of ivermectin might be rather slow, even for high-risk patients and for higher doses. The case of the 85-year-old patient is well documented. The documentation is available on demand.
The publication with the conclusion that ocular use of ivermectin 1% cream (Soolantra) is “safe and effective” is an open access article.
It can be found on the internet under: B. Sobolewska, Deshka Doycheva, Christoph M. Deuter, Martin Schaller & Manfred Zierhut (2020): Efficacy of Topical Ivermectin for the Treatment of Cutaneous and Ocular Rosacea, Ocular Immunology and Inflammation (DOI: 10.1080/09273948.2020.172753).
Comment via email from Betsie.
“I’ve been using Soolantra on my eyelids for one year for ocular rosacea & blepharitis with average results. The BEST treatment gel for blepharitis is HYLO gel- not available in the US. I purchase mine from Canada. It’s a cure, but must be used morning & night.
A better feeling is just a thought away!”
David, I’m very interested in your comment about Hylo Gel. Treating my eyelids has been the number one priority for me ever since I discovered what a difference it can make. But I haven’t found anything really satisfactory, and I usually develop a sensitivity to whatever I’m using after a while of using whatever. I’m currently using Derma Care, which is better than nothing. Do you apply the Hylo Gel along your eyelid margins? Does it leave a stiff or plasticy feeling? Does it wear off easily? Thank you.