Demodex Treatment

What is Demodex?

Demodex folliculorum and Demodex brevis, or known as “Demodex” are a normal part of our facial and ocular biome (1-3). When demodex colonizes in large quantities on the eyelids, excessive yellow crusting can be found on the eye lashes upon waking in the morning. High populations of demodex found on the face is a strong pathogenesis risk factor for oculofacial rosacea, meibomian gland dysfunction (MGD), and dry eye disease (DED) (4,5). The toxins from build up of yellow crusting can cause a harmful environment to the ocular surface leading to a cycle of inflammation and dry eye disease.

How can we get rid of Demodex?

As a starter with over the counter methods, you can start by washing your face daily with a gentle cleanser focusing more on the eyelid margin area. Over the counter eyelid cleansers or foams contain ingredients that can soothe and refresh the delicate skin of the eyelids. There are also eyelid wipes that are infused with tea tree oil that can aid in removing demodex. Sometimes over the counter products are not enough to keep the demodex population at bay. In-office treatments such as BlephEx, OptiLight and Zest are more effective in eliminating the mites. BlephEx is a tool that mechanically exfoliates the lid margin and removes Demodex and biofilm along the lid margin creating a healthier ocular surface. OptiLight is a powerful light based therapy that can kill much of the demodex living on the lid margin. (5). Zest is a gel cleansing spa-like treatment incorporating patented Zokrex (TM) technology with natural okra polysaccharide complexes that has antibacterial, antifungal and anti-inflammatory actions to eliminate demodex (6).

Photo references below.

Author: Josephine Ko, OD, FAAO

References

1. English FP, Nutting WB. Demodicosis of ophthalmic concern. Am J Ophthalmol 1981;91:362–372. 2. Chen W, Plewig G. Human demodicosis: revisit and a proposed classification. Br J Dermatol 2014;170:1219–1225.

2. Grice E. The skin microbiome: potential for novel diagnostic and therapeutic approaches to cutaneous disease. Semin Cutan Med Surg 2014;33:98–103.

3. Szkaradkiewicz A, Chudzicka-Strugała I, Karpin´ski T, et al. Bacillus oleronius and Demodex mite infestation in patients with chronic blepharitis. Clin Microbiol Infect 2012;18:1020–1025.

4. Jarmuda S, Mcmahon F, Zaba R, et al. Correlation between serum reactivity to Demodex-associated Bacillus oleronius proteins, and altered sebum levels and Demodex populations in erythematotelangiectatic rosacea patients. J Med Microbiol 2013;63(Pt 2):258–262.

5. Real-Time Video Microscopy of In Vitro Demodex Death by Intense Pulsed Light, Harvey A. Fishman, Laura M. Periman, and Ami A. Shah, Photobiomodulation, Photomedicine, and Laser Surgery202038:8, 472-476.

6. Liu W, Gong L. Anti-demodectic effects of okra eyelid patch in Demodex blepharitis compared with tea tree oil. Exp Ther Med. 2021 Apr;21(4):338. doi: 10.3892/etm.2021.9769. Epub 2021 Feb 10. PMID: 33732311; PMCID: PMC7903416.

7. Photo Demodex folliculorum on left cited from: © Palopoli et al.; licensee BioMed Central. 2014

8. Photo of Eyelids: Original work by Northeast Optometry.