Demodex: Eye Mites

Electron micrograph of eyelash mites
Electron micrograph of eyelash mites. STEVE GSCHMEISSNER / Getty Images

Many people complain of red, irritated, scratchy and sometimes swollen or thickened eyelids. The diagnosis is often a condition called blepharitis. Blepharitis is an inflammation of the eyelids. Blepharitis can present in several different forms but is thought to be caused by staphylococcus bacteria that we all have on our skin, but some individuals have more of it on their face and eyelids. Blepharitis can also be caused by inflamed or clogged eyelid glands, called meibomian glands.

Meibomian glands secrete oil and help to maintain the quality of your tears. Patients with significant blepharitis sometimes have rosacea, a skin condition that usually includes blepharitis.

Treating Blepharitis

For years, the typical treatment regimen for blepharitis has been a combination of eyelid hygiene and medications. Many times doctors prescribe eyelid scrubs and warm compresses. Eyelid scrubs can be composed of a warm washcloth and gentle baby shampoo (it won’t sting your eyes). More commonly, commercially prepared lid scrubs that are pre-medicated are recommended by doctors. Sometimes, doctors will prescribe oral and topical antibiotics as well. However, some patients never seem to respond very well. It may improve but the condition becomes chronic or never seems to disappear.

Demodex

Sometimes the condition does not respond to treatment because the doctor focuses on treating the wrong contributing organism.

Recently, much attention has been focused on demodex. Demodex is a type of mite that most of us have living on our skin. Demodex is very common and seems to be present in greater numbers on our skin as we get older. Demodex infestation is present in 84 percent of the population at age 60, and 100 percent in patients older than 70.

So the older you are, the higher the chance you may have more demodex. Although demodex is definitely present in higher amounts in people who do not practice good hygiene, it doesn’t necessarily mean you are doing a poor job with personal hygiene. Demodex just seems to grow better in areas that are more difficult to routinely clean, such as the eye socket, cheekbone, and nose. The eye socket area or orbit is an area that has a lot of valleys and is not easy to clean. Most of us don’t regularly scrub that part of our body as well as we should.

Symptoms of Demodex infestation

  • itching

  • burning

  • foreign body sensation

  • crusting

  • redness of the lid margin

  • blurry vision

Patients with demodex infestation often have cylindrical dandruff on the skin and eyelashes, redness and irritation of the eyelid margin and sometimes misdirected or missing eyelashes. Doctor’s have known about demodex for many years, but for some reason, but many have overlooked it. It is difficult to visualize them under the slit lamp biomicroscope used in eye doctor’s offices.

How to treat Demodex

There are several ways to treat demodex. The first is to simply improve hygiene regimens. Most of us are not as diligent as we should be about washing our faces. It is best to clean the entire body with a good soap or shampoo and this includes the face. Don’t miss the forehead, eyelid and skin around the eye. It is also important to wash you hair daily if you have demodex. Believe it or not, tea tea tree oil has been found to eradicate demodex. Doctors recommend a daily lid scrub with 50% tea tree oil.  Applying tea tree oil may be difficult and messy. However, there is a new eyelid scrub cleansing pad on the market called Cliradex. Cliradex contains terpinene, the main ingredient in tea tree oil that seems to help eliminate demodex. Cliradex is available in a single use, disposable cleansing pad.  Take care not to grab some of the other commercially prepared lid scrubs. They are better at treating blepharitis caused by staphylococcus but doctors haven’t found them to be very good at killing mites. Another important tip for keeping demodex away is to wash your bedding frequently in very hot water. Heat kills demodex effectively.

SOURCE: Blepharitis Diagnosis: Don’t Forget Demodex; Michelle Stephenson, Review of Ophthalmology, 9/6/2012

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