Demodex Blepharitis and its Treatments


Many people experience eye inflammation, red bumps, crust or red eyelids. Blepharitis is one of the most common issues ophthalmologists see. In fact, up to 50% of people who visit their optometrist have at least some signs of this disorder and up to 2 million individuals report having this condition every year, and many use Cliradex Towelettes to treat demodex blepharitis. This is what people should know about demodex blepharitis.


Blepharitis Overview

Blepharitis is a common eye ailment that causes inflamed eyelids where the eyelashes grow. When the eyelids become irritated, swollen and scaly, they can become infected. Clogged oil glands or hair follicles often cause this inflammation.

Anterior blepharitis occurs in the area where the eyelashes are. It may appear that the eyelashes have dandruff and the eyelids appear dark or red. Posterior blepharitis involves swelling underneath the eyelids when the oil-producing glands get clogged or produce thicker oil.

Blepharitis tends to be chronic, but it is not contagious. Treatments, such as Cliradex Towelettes, often include tea tree oil ingredients. Although bacteria and allergies often cause this condition, demodex mites cause many cases.

What Are Demodex Mites?

Demodex or face mites live in hair follicles and sebaceous glands, where the body produces oil. They are part of the body’s regular fauna, eating dead skin and excess oil. These microscopic mites have scaly, cigar-shaped bodies with three segments with eight legs and pincher-like mouths. They come out when their hosts sleep and lay eggs in the hair follicles, which hatch within four days. After two weeks, they die and break down in sebaceous glands and hair follicles.


Demodex lives on cheeks, eyelashes, ear canals, nose, forehead and scalp. Although they are a parasite, they do not typically harm the human they live on unless they overproduce. Then, these mites can cause demodex blepharitis, demodicosis and demodex folliculitis.

Two types of demodex mites live on humans: demodex folliculorum, which eat skin cells and live in small hair follicles, and demodex brevis, which live in sebaceous glands and eat a substance called sebum. Demodex mites transfer among people through hair, oil gland and eyebrow contact.

Demodex Blepharitis Overview

Blepharitis is a common diagnosis, and up to half of these cases link to demodex. However, some studies found that up to 58% of cases (25 million) were the result of demodex. Individuals with dry eyes, who could not wear contacts or had cataracts often suffered from demodex blepharitis (DB). In addition, most patients (80%) reported reduced quality of life for more than four years.

Although some feel that demodex helps humans by keeping other mites, bacteria and microbes at bay, others feel that overpopulation has negative impacts. However, the correct balance of mites is unclear.

How Demode Cause Demodex Blepharitis

Because demodex folliculorum eats the epithelial cells within hair follicles, they could cause abrasions that produce hyperplasia and hyperkeratinization, which are tissue enlargement due to the cell reproduction rate and the skin’s outer layer thickening, respectively. As the skin thickens, it disrupts hair growth and may lead to eyelash loss or lashes growing toward the eye instead of outward.


Demodex brevis live in the sebaceous glands and meibomian glands, which are tubular sebaceous glands that secrete cytoplasm and dead cells. When the demodex burrow into these glands, they become clogged, and the mites’ waste makes the clog worse, causing cylindrical dandruff or collarettes and inflammation. In addition, the chitin of the demodex exoskeleton makes the body produce a granuloma, a cluster of white blood cells and tissues.

Streptococcal and staphylococcal bacteria live on demodex mites and they have bacillus oleronius inside them. These bacteria cause Type IV hypersensitivity and inflammation, which can become chronic and lead to other issues, such as inflamed conjunctiva and corneas.

Who’s at Risk of Demodex Blepharitis?

By adulthood, most people have demodex. They do not distinguish between races or genders. However, their concentrations increase during puberty and as adults get older. Children rarely have demodex blepharitis, but they are more prevalent in immunocompromised pediatric patients.

Adults with compromised immune systems, such as those with cancer, HIV or other conditions that require immunosuppressant drugs, have higher instances of DB. In addition, diet, mental health, environment, smoking, diet, skin conditions and fair complexion also make people vulnerable.

Not every person with demodex overpopulation experiences blepharitis. Individuals with collarettes or cylindrical dandruff in the eyelashes have DB if the collarettes cause the disease.


What Are the Signs and Symptoms

DB causes inflammation around the eyelashes and on the eyelids. They may develop dandruff-like flakes. Eyelid irritation and dysfunction may also occur. Additional symptoms include:

•        Stinging

•        Burning

•        Blurred vision that gets better after blinking

•        Abnormal eyelash growth


•        Waxy structures around the base of the lashes

It may appear that debris is collecting along the eyelid or blood vessel dilation, and skin breaks may appear where the skin and mucous membranes are close to the skin’s surface. Chronic or untreated inflammation may produce notches or scallop shapes in the lids.

What Conditions Are Associated With With Demodex Blepharitis

Dry eye and ocular rosacea are common comorbidities of DB. It also causes meibomian gland dysfunction (MGD), blepharitis and the development of chalazion or hordeolum, a red bump on the eye that is tender. DB also reflects herpetic keratitis and can cause conjunctivitis, eyelash challenges and other ocular diseases.

How Is Demodex Blepharitis Diagnosed?

Most DB diagnoses result from symptom identification. However, clinicians also use both invasive and noninvasive detection methods. Invasive methods include:

•        Eyelash sampling


•        Skin cell scrapes

•        Skin biopsies

Medical professionals view these samples under a microscope. Non-invasive methods include:

•        Confocal laser scanning microscopy

•        Dermoscopy where light and magnification reveal spiky white areas in the pores


•        Slit lamp examination while the patient looks down to identify collarettes

•        Rotating the lashes without pulling them out to encourage the mites to come out

When doctors treat patients for different eye diseases with steroids, antibiotics and antivirals and they do not respond, may conclude that mites are the cause. Clinicians also try to determine the number of demodex mites through lash sampling, but they need to separate the debris and mites using a special solution of peanut oil, sodium fluorescein and 75% alcohol.

Treatment Options

Demodex does not typically respond to traditional treatments, such as antiviral, antifungal and antibacterial treatments. Anti-inflammatories only treat the symptoms. However, several antiparasitic treatments do help with DB.

Tea Tree Oil

Tea tree oil (TTO) is the most common treatment for DB. The oil forces the mites out of hair follicles and sebaceous glands, so they cannot lay eggs. It also cleans the lashes and gets rid of some of the symptoms, including collarettes.


Unfortunately, TTO therapies have some side effects, especially at high concentrations, including irritation, allergic reactions and contact dermatitis. Many foams, wipes, scrubs and cleaners, such as Cliradex towelettes, contain proper TTO dosages.


The primary active ingredient in TTO is 4-tepinnoel. This ingredient is antimicrobial, antifungal, anti-inflammatory, antibacterial and antiseptic. It kills the mites because it inhibits acetylcholinesterase, an enzyme that breaks down acetylcholine, which is a neurotransmitter. Of the 15 ingredients in TTO, 4-tepinnoel was the most effective on the mites, and it was more effective alone because many parts of the oil actually reduce its efficacy. Cliradex products, including Cliradex Towelettes, contain 4-tepinnoel.

Hypochlorous Acid

Hypochlorous acid is an antiseptic that attacks the bacteria on the mites as well as within the follicles and on the eyelids. Although some studies show that this acid, which is a natural antiseptic produced in the immune system, is effective, clinicians often combine this treatment with Cliradex Towelettes and other TTO products. This treatment is common when patients have TTO allergies.

In-Office Debridement

In-office visits often focus on cleaning and removing the damaged, thick skin on the lid margin and lashes. Microblepharoexfoliation removes the waste, eggs, proteins, bacteria and debris using a machine, reducing the mites and bacteria. This treatment often accompanies TTO treatments.

Zocular Eyelid System Treatment

Zocular eyelid system treatments use a cleansing gel made from okra. This gel exfoliates or debrides the eyelashes and lids.


Thermal Pulsation

Several procedures, including LipiFlow and TearCare, use thermal pulsation treatments. Many clinicians direct patients to add warm compresses to the eyes at home. This treatment focuses on the symptoms rather than the root cause. Therefore, additional treatments, including TTO products, such as Cliradex Towelette, are necessary.

Intense Pulsed Light Therapy

Intense pulse light (IPL) therapy targets tissues using high-intensity polychromatic light. This process targets the exoskeletons of the mites, heating them rapidly and causing death. It also reduces bacteria and inflammation.

Omega-3 Supplements

Omega-3 supplements improve inflammatory conditions, such as MGD, but they should contain a three-to-one ratio of EPA to DHA. These supplements adjust gland secretions, preventing inflammation of these glands, but they should not be the only treatment used to treat DB.

Prescription Medications

Xiidra, Restasis and other anti-inflammatories treat the symptoms of DB. Additional treatments, including vasoconstrictives, may treat rosacea or the coloration of the eyelid and lash areas. Again, demodicid treatments, such as Cliradex Towelettes with 4-tepinnol should accompany prescriptions that treat the symptoms.

Cliradex Towelettes for DM Relief

Those experiencing DB symptoms should consult a physician. After proper diagnosis, the treatment should focus on both the symptoms and the underlying cause. Therefore, it should include 4-tepineol products, such as Cliradex Towelettes or Cliradex Foam.


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