HealthcareA Patient’s Guide to Demodex Blepharitis

Eye irritation is a common complaint, often triggered by allergies, seasonal changes, tobacco smoke, chlorinated water, dust, dirt, sand, infection, old makeup, extended-wear contacts, or certain medical conditions. Following simple hygienic practices and avoiding environmental contaminants can help to avoid some of these irritants. However, there is another simple explanation for eye irritation that mimics these symptoms that some people find distressing. The Demodex mite is a microscopic ectoparasite that is part of the natural biology of human skin, but an overpopulation of these mites can result in disruption to the eyelids and lashes.

What Is Blepharitis?

Over two million Americans are diagnosed each year with blepharitis, a common eye condition usually caused by allergies or an overgrowth of bacteria. Blepharitis causes eyelid inflammation, often with redness, swelling, flaky particles in the lashes, and an accompanying itching or burning sensation. While these conditions are usually responsive to antibiotics or other standard treatments, some cases are resistant to routine care. In these instances, the correct diagnosis is often Demodex blepharitis, which must be treated with Cliradex towelettes or other product geared toward eradicating the Demodex mite.

What Is Demodex Blepharitis?

Approximately 58% of patients in eye clinics show symptoms of the eyelashes, skin, and sebaceous glands that can be attributed to Demodex blepharitis, an infestation of the Demodex mite. This places the estimated number of total cases in the United States at around 25 million. If Demodex blepharitis is left untreated, the condition can worsen and cause more serious issues such as scarring or even blindness. Currently the condition is relatively underdiagnosed and the potential for damage is not widely understood.

What Is a Demodex Mite?

The Demodex mite is an eight-legged ectoparasite that is part of the natural microflora of the human skin. Although the mite is a close cousin of the spider, it is too small to be observed without a microscope. Nearly every human has a population of these mites on their body. There are two types of mites: the Demodex folliculorum is generally found on the face, with the Demodex brevis localized on the chest and neck areas. When overpopulation of these mites is not controlled with a treatment option such as Cliradex towelettes, they can cause a variety of issues in the hair follicles, specifically in the eye area leading to dry eye, conjunctivitis, and eyelash dysfunctions.

Who Is at Risk for Demodex Blepharitis?

Demodex mites increase in number as part of the normal aging process. With evidence of these ectoparasites present in 84% of adults over 60 and 100% of adults over 70, Demodex mites are the most common cause of blepharitis for this population. Immunocompromised individuals are also at risk for Demodex blepharitis, including those with HIV, cancer, or under immunosuppressive therapy. Other risk factors include fair complexion, rosacea, high stress, smoking, alcohol consumption, a diet high in spices, and exposure to excessive sunlight or sudden changes in temperature.

How Do Demodex Mites Cause Demodex Blepharitis?

Demodex mites live and mate inside hair follicles. They eat the epithelial cells that are present on eyelash follicles, creating microabrasions from their bites. Over time, the margin of the eyelid can thicken from these injuries, creating loss and misdirection of lashes. When the population is not controlled with a treatment option such as Cliradex towelettes, the mites also excrete waste and lay eggs in lash follicles, leading to inflammation of the eye area. Larvae usually take 3-4 days to hatch and reach full maturity in just a week, with the full lifespan only reaching about two weeks. When the mites die, their bodies decompose in the skin’s sebaceous glands and hair follicles, resulting in additional debris and irritation to the eyes, lashes, and lids.

What Are the Signs and Symptoms of Demodex Blepharitis?

The bites, eggs, and waste products of the Demodex mites create a waxy substance known as lash collarettes or cylindrical dandruff that coats the base of the eyelashes. This is considered the hallmark symptom of Demodex blepharitis. Other symptoms that patients may notice include burning, stinging, foreign body sensation, blurred vision, excess tears, and general irritation of the eye area. In addition, eyelashes may fall out or become disjointed when they are not cleaned and maintained with a product such as Cliradex towelettes.

What Conditions Are Associated With Demodex Blepharitis?

Dry eye is the most common ocular condition associated with Demodex blepharitis. However, Demodex mites have also been attributed to a variety of other conditions, including blepharitis, chalazia, conjunctivitis, keratitis, recurrent trichiasis, and rosacea.

How Is Demodex Blepharitis Diagnosed?

Demodex blepharitis is diagnosed following presentation of typical symptoms. However, eye redness, irritation, and excessive tears can be attributed to other conditions. While the existence of Demodex can be strongly inferred from the observation of lash collarettes, a formal diagnosis of Demodex blepharitis generally relies on a microscopic analysis of an eyelash sample.

What Are the Best Treatment Options For Demodex Blepharitis?

The parasitic Demodex are extremely resistant to most treatment options, including antibacterial, antifungal, antimicrobial, or antiviral agents. The most effective forms of treatment include agents formulated to simultaneously treat the symptoms while targeting the mites.

Tea Tree Oil

The most effective treatment ingredient that has been found for Demodex is tea tree oil, extracted from the Melaleuca alternifolia, or tea tree, for which it is named. This antimicrobial agent has been shown to efficiently cleanse the lashes and remove collarettes. Patients utilizing tea tree oil should exercise caution because the substance can cause eye irritation when used at high strength levels. The most beneficial concentration levels are 2-5%, with adverse side effects a possibility in higher amounts. Cliradex towelettes and Cliradex foam are both formulated with tea tree oil and other soothing ingredients for optimal treatment levels while minimizing the likelihood of eye irritation.

4-Terpineol

Tea tree oil’s functional ingredient is terpinen-4-ol, which is also known as 4-terpineol, an antimicrobial and antiseptic substance that includes antibacterial, antifungal, anti-inflammatory, antiviral, and demodicidal properties. 4-terpineol kills Demodex mites, forcing them out of the lash follicles where they dwell and stopping the cycle of laying eggs and secreting waste. 4-termpineol has been shown to have better efficacy at lower concentration levels, which informed the formulation of Cliradex towelettes and Cliradex foam products.

Hypochlorous Acid

Hypochlorous acid is a great antibacterial agent, which is suggested by some studies to reduce the presence of Demodex. Its broad use as an antiseptic agent can eliminate bacteria on the lashes and eyelids, making it a good hygiene product to pair with tea tree oil or 4-terpineol in a product such as Cliradex towelettes or Cliradex foam.

In-Office Debridement

An exfoliation process can be performed in a medical office to reduce the amount of bacteria and Demodex debris present on the eyelid and in the lashes. This debridement procedure can slow the lid thickening process and remove the collarettes that have accumulated on lashes and lids. This procedure should be followed with at-home maintenance using a product such as Cliradex towelettes or Cliradex foam.

Zocular Eyelid System Treatment

The Zolcular Eyelid System Treatment, or ZEST, is an alternate form of exfoliation for lashes. This procedure involves manual eyelash and eyelid debridement along with a cleansing gel made from an okra derivative.

Thermal Pulsation

Thermal pulsation is another treatment option that relies on an in-office procedure involving a thermal device such as iLux by Alcon, LipiFlow by Johnson & Johnson, or TearCare by Sight Sciences. This device applies pressure and heat to the glands, which melts the clogged meibum and clears debris from obstructed glands.

Intense Pulsed Light Therapy

Intense pulsed light therapy, or IPL, delivers high intensity (515-1200 nm) polychromatic light to target areas. This treatment option is ideal for Demodex blepharitis because it works on numerous levels. The pulsed light rapidly heats the Demodex mites, killing them almost instantly, while simultaneously decreasing bacteria levels and inflammation. The typical treatment regimen for Demodex blepharitis would include 4 treatments administered every 3-4 weeks.

Omega-3 Supplements

The use of supplements have shown promise in treating Demodex blepharitis, particularly those including Omega-3 fatty acids. A triglyceride-based supplement with at least 2 grams of combined DHA and EPA and a 3:1 ratio of EPA and DHA is recommended along with the use of Cliradex towelettes or Cliradex foam to most efficiently reduce inflammation and improve the symptoms associated with Demodex blepharitis.

Prescription Medications

There are numerous prescription medications that can be used to treat Demodex blepharitis, but all should be used with a demodicial agent such as tea tree oil found in the Cliradex towelette or Cliradex foam. This will help to address the underlying Demodex infestation to ensure the symptoms can be managed and reduced without another inflammation cropping up. Prescription medications that have shown promise in treating the condition include the following:

• Cequa
• Doxycycline
• Lumify
• Restasis
• Xiidra

Summary

Demodex blepharitis causes general eye irritation, lash disruption, conjunctivitis, and keratitis. While the symptoms of Demodex blepharitis are sometimes difficult to distinguish from other eye conditions, patients over 60 and those with known risk factors should consider the possibility that an overpopulation of Demodex mites living in the hair follicles is to blame. With a proper diagnosis of Demodex blepharitis, patients can utilize Cliradex towelettes formulated with tea tree oil to clean the lids and lashes, remove existing collarettes, and reduce the growth and spread of the mites.

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