Important Facts About Demodex Blepharitis and Treatment

By on October 27, 2021
Blepharitis

Blepharitis affects as many as 25 million Americans in the United States. This irritating eye condition is caused by the buildup of oily particles and bacteria at the edge of the eyelid near the eyelash base. Sometimes the swollen oil glands can cause a stye or painful red bump. Over time, these conditions may slowly damage the eyelid. Blepharitis is often referred to as Demodex blepharitis due to findings showing that two species of Demodex mites are big culprits of this eye condition. Let’s dive into this common eye condition and the best practices for Demodex blepharitis treatment. 

What Role Do Demodex Mites Play in Blepharitis? 

Blepharitis and Demodex mites are intertwined. Out of the 65 known Demodex species, only two affect humans.3 These arachnid ectoparasites can reside in our hair follicles and/or sebaceous glands. When a person’s eyelashes and eye follicles are infested with mites of the Demodex folliculorum species, this condition refers to anterior blepharitis. When a person’s meibomian glands are infested with mites of the D. brevis species, this condition refers to posterior blepharitis. Meibomian glands are the oil or sebaceous glands lining the edge of your eyelid. 

The Mite-y Life 

The life cycle of the Demodex mite spans anywhere between 14 to 23 days, with only about five days spent in the adult stage. Because of the short adult life span, mating plays the biggest role in prolonging infestation. A female Demodex can lay anywhere between 15 to 20 eggs inside the hair follicle. These eggs then grow into larvae and eventually mature into an eight-legged adult mite. Adult male mites will leave the follicle to find a mate, while female mites remain inside the follicle. 

Demodex mites also have a very short life span when outside their living host. Thus, treatment strategies focus on preventing mite mating and transmission via direct contact. 

The Mite-y Damage 

  • Exterior Havoc – Demodex mites, folliculorum in particular, eat up skin surface cells near the hair follicle causing the follicle to bulge, which can lead to loose or distorted lashes. These lashes often become brittle and fall out easily. The mite’s claws also cause micro-abrasions that can induce increased skin cell growth and hyperkeratinization around the eyelash base, leading to the classic cylindrical dandruff that characterizes blepharitis. 
  • Interior Havoc – D. brevis mites can block the openings of meibomian glands causing gland dysfunction and lipid tear deficiency. These mites like to burrow deep in the meibomian gland, leading to inflammation. Their tendency to cause gland blockage may be a potential reason for recurring chalazia or red, irritated bumps at the eyelid edge. Recurring infestations can cause severe eyelid margin inflammation over time. If left untreated, inflammation can either spread to the cornea or even the eye conjunctiva producing a condition known as blepharoconjunctivitis. 

The Mite-y Germ Taxi 

Demodex mites cause blepharitis because of the bacteria they carry, including Streptococci and Staphylococci. These bacteria produce superantigens that play a role in promoting rosacea and they can also help to trigger the immune response. Even dying mites can trigger bacterial antigens, leading to the inflammatory response. 

What Are Common Signs and Symptoms of Blepharitis? 

Those who suffer from Demodex blepharitis can exhibit the following: 

  • Clear cylindrical dandruff at the eyelash base 
  • Itchy eyelids and/or eyebrows 
  • Loss of eyelash or eyebrow hairs, known as madarosis 
  • Burning or itching sensation underneath eyelid 
  • Feeling of a foreign body underneath the eyelid
  • Blurry vision 
  • Redness and crustiness at eyelid margin

Who Is Susceptible to Blepharitis? 

Demodex blepharitis is a common eye condition that affects males and females equally. The chance for this eye condition to occur increases with age. A study by Junemann demonstrated that Demodex mites can be found in approximately a quarter of 20-year olds, a third of 50-year olds, and 100% of people older than 90 years.2 

Certain health conditions predispose patients to Demodex blepharitis. In rosacea patients, sebaceous glands are usually congested creating an excellent environment for Demodex mites to thrive. Patients who require immunosuppressive regimens or who are diagnosed with immunocompromising diseases are more easily susceptible to blepharitis. Cancer and HIV patients are examples of susceptible populations. 

There are preventable factors that promote the infestation and proliferation of Demodex mites, such as: 

  • Excessive sunlight exposure 
  • Alcohol intake 
  • Stress
  • Smoking 
  • Hot beverages and spicy foods 
  • Abrupt temperature changes 
  • Poor eyelid hygiene 

Physical factors that can promote Demodex mite proliferation include: 

  • Certain skin phototypes 
  • Oily skin types 
  • Patients prone to dandruff 

The Emotional Impact of Blepharitis 

In a study examining the psychosocial impact of Demodex blepharitis, 80% of patients reported that this condition negatively impacted their daily lives in the following ways:4 

  • Longer time needed to perform daily hygiene routine 
  • Difficulty with night-time driving 
  • Decreased eye contact wear 
  • Increased self-consciousness or constant worry about their eyes 
  • Increased trouble wearing make-up 
  • Negative self-perception of appearance 
  • Decreased self-esteem 

Evidence of both the physical and emotional impact of Demodex blepharits promotes the importance of effective treatment regimens for this common eye condition. 

What Are Conventional Practices for Demodex Blepharitis Treatment? 

While there is no cure for blepharitis, current regimens focus on Demodex eyelid treatment to maintain and control symptoms. There are numerous ways to treat this irritating condition. Daily conventional practices for symptom relief include: 

Skin and Eyelid Hygiene

Maintaining the cleanliness of your eyelids, skin, and hair is extremely effective for keeping the irritating symptoms of blepharitis under control. Gently wash your eyelashes daily with baby shampoo diluted in clean warm water and wash your hair, including your scalp and eyebrows, with an antibacterial shampoo. Tea tree shampoo and cleansers are good choices for maintaining skin and eyelid health. 

Warm Compresses

Warm compresses help to unclog sebaceous glands, loosen sticky lash crust, stabilize tear film, and provide relief from the bothersome effects of inflammation. Easily assemble a warm compress at home by wetting a clean cloth with warm water. Wring out excess water and place the compress over you closed eyes for a few minutes. You may have to wet the washcloth continuously to maintain its warmth. 

Baby Shampoo Scrubs

Dilute baby shampoo in warm water and use to soak a clean cotton swab, lint-free pad, or clean washcloth. Gently scrub your eyelash base for about 15 seconds. Both the short scrubbing time and dilution are necessary since baby shampoo is a detergent and can negatively affect your tear production.

Antibiotics

If prescribed by your ophthalmologist, topical antibiotic ointments are effective ways to decrease mite proliferation. Apply a small amount of ointment onto a cotton swab and gently apply to your eyelash base. Either apply before bedtime or when your doctor recommends. Sometimes your doctor may prescribe an oral antibiotic to help control your symptoms depending on their severity. 

Eye Drops

There are over-the-counter artificial tears you can apply to alleviate dry eyes and swelling. Your ophthalmologist may also prescribe a steroid eye drop to reduce redness and swelling or an antibiotic eye drop to improve the function of your oil glands. Excessive use should be avoided as this can increase irritation over time. 

How Effective is Tea Tree Oil for Demodex Blepharitis? 

While symptom control is a big part of blepharitis treatment, another treatment goal is the removal of adult mites and their offspring to prevent further mating and re-infestation. Tea tree oil lid scrubs have the ability to cleanse cylindrical dandruff and stimulate mites to migrate onto the skin surface for easier eradication. 

Four weeks of daily lid scrubs with 50% tea tree oil and lid massages with 5% tea tree oil ointment has been shown to reduce the Demodex mite count to zero in many patients. While the exact mechanism is unknown, 50% TTO has a direct miticidal effect, while the 5% TTO ointment may prevent mating.2 Ophthalmologists often recommend tea tree oil for Demodex blepharitis due to its role in reliable symptom relief and decreased inflammation of the lid margin, conjunctiva, and cornea. 

How Can 4-Terpineol Improve Current Blepharitis Treatment? 

While TTO regimens are effective for decreasing overall mite count, 50% TTO can be very irritating to the skin with frequent usage, which is a big consideration in this patient population. To effectively decrease the chemical ingredient composition of TTO to lessen the possibility of skin irritation, the 15 main active ingredients of TTO were evaluated for their killing effect on mites. Of these ingredients, Terpinen-4-ol was ranked the highest in potency, demonstrating effectiveness even at concentrations as low as 1%.5 

A big advantage of T4O over tea tree oil for Demodex blepharitis is that it is more efficient at killing mites. A study by Tighe and associates demonstrated that T4O had more rapid kill times than tea tree oil at similar concentrations. Moreover, 1% T4O dilution was able to eradicate Demodex mites in <90 minutes, whereas 10% TTO dilution could not.6 

On top of being more efficient than tea tree oil in decreasing mite count, T4O has also been shown to be well-tolerated and effective in killing bacteria common in ocular infections. A study demonstrated that 2% T4O dilution does not cause irritation in the eyes or skin and that it could effectively kill microorganisms within 60 seconds.7 T4O’s utility in Demodex blepharitis treatment is clearly warranted.

Currently, Cliradex is the only commercially available product containing T4O specifically for ophthalmic use. Feel free to contact our team regarding any questions you may have on our products. 

Sources Used: 

  1. https://www.aao.org/eye-health/diseases/what-is-blepharitis
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2946818/
  3. https://www.healio.com/news/optometry/20120225/demodex-infestation-requires-immediate-aggressive-treatment-by-doctor-patient
  4. https://iovs.arvojournals.org/article.aspx?articleid=2774001
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860352/
  6. https://www.dovepress.com/in-vitro-demodicidal-activity-of-commercial-lid-hygiene-products-peer-reviewed-fulltext-article-OPTH
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093255/

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Important Facts About Demodex Blepharitis and Treatment