A Comprehensive Guide to Demodex Blepharitis

When your eyelids are inflamed, red or irritated regularly, it could indicate Demodex blepharitis. Demodex blepharitis is caused by Demodex mites living on your skin and while DB may sound alarming at first, various treatment options are available. As you learn about DB, you'll discover the many treatments, including debridement, prescriptions and TTO cleansing wipes like Cliradex Towelettes.

What Are Demodex Mites?

Demodex mites are an ectoparasite that naturally lives on human skin. As part of human's natural microflora, they don't typically cause problems. People with a healthy amount of Demodex won't see signs of them.

Demodex are arthropods that use their four pairs of legs to grip onto eyelashes and to burrow into follicles and glands. While there are various species of Demodex, humans only have two species. One species is the D. brevis, inhabiting sebaceous glands, whereas the other, D. folliculorum clings to lashes. D. brevis eat sebum and D. folliculorum eat skin cells.

What Is Blepharitis?

Blepharitis refers to inflammation of the eyelid. Blepharitis can occur for multiple reasons, including Demodex and bacteria. Too much bacteria can block your oil glands and lead to irritation and inflammation.

If Demodex cause blepharitis, then it may be due to having too many on the skin and lashes. As D. folliculorum feed on epithelial cells in the hair and follicle, the bites cause microabrasions. The microabrasions can cause lash loss, misdirection, lid margin thickening and lash disruption.

Demodex do not have a developed excretory system, so they must regurgitate undigested material. Unfortunately, the material contains a proinflammatory digestive enzyme that may cause irritation to your lids and disrupt the tear film on your eyes. As the waste mixes with other debris, it creates a wax, cylindrical coating on the base of the lashes. Even after Demodex die, their bodies still release proinflammatory proteins that can result in blepharitis.

Different bacteria can also live on the bodies of Demodex. Streptococcal and staphylococcal thrive on the surface of the mites and Bacillus oleronius live on their abdomens. Since all of these bacteria species can cause inflammation, some of the damage may occur due to the bacteria. However, if you don't remove the Demodex, you can't eliminate the bacteria.

Who Is At Risk for Developing Demodex Blepharitis?

Since Demodex are a natural component of the skin's microflora, every person has the potential to develop the condition. While Demodex's population does not correlate with gender, it can change with age. The older population tends to have a higher Demodex density. For example, over 80% of adults over 60 have Demodex on their skin. In persons over 70, 100% of the population have Demodex. Demodex can occur on healthy children too, but most pediatric patients are immunocompromised.

Likewise, immunocompromised adults tend to have a higher risk for Demodex blepharitis. Those who have cancer or HIV tend to have a higher risk. Other risks factors include:

Fair skin
Rosacea
Diet
Stress
Sunlight exposure

Many risk factors that accompany high levels of Demodex also affect a person's chances of developing rosacea. Demodex may be an underlying factor in rosacea.

However, the presence of Demodex does not always mean that you'll have signs of blepharitis. The presence of Demodex may help block the overgrowth of harmful microbes, like other mites or bacteria. Your microflora have a balance and an overgrowth of Demodex can upset the natural balance and lead to further issues.

What Are the Signs of Demodex Blepharitis?

One of the most common signs of DB is the waxy collarettes that wrap around the base of the lashes. In addition, you may have an obstruction or inflammation of your glands which can cause a chronic, painful infection to the inside of your eyelid. Signs of an infection include:

Red or pink coloring in the whites of your eyes
Increased tears
Swelling of the thin layer of the conjunctiva inside the lid
Discharge from the eyes
Crust on lashes or eyelids

When you have DB, it may feel like you have something in your eye, despite finding no foreign objects. It can also cause light sensitivity and blurred vision.

How Is Demodex Blepharitis Diagnosed?

When diagnosing DB, the physician will consider all of your symptoms. However, in some cases, patients may not have symptoms or may have symptoms that overlap with other conditions. Physicians can easily overlook DB if based only on the symptoms like ocular irritation, tearing and red eyes.

Generally, cylindrical dandruff indicates that a patient has Demodex blepharitis. To identify collarettes, physicians will use a slit lamp examination to find collarettes on the lashes. Next, doctors can confirm the diagnosis with a microscopic analysis of the eyelashes.

What Other Conditions Are Associated With Demodex Blepharitis?

There are various conditions related to DB that may occur as comorbidities. Some conditions include ocular rosacea or dry eye.

Meibomian Gland Dysfunction

Meibomian glands are glands that produce oil to help your tears from drying too quickly. Without meibomian glands, tears would evaporate too fast and your eyes would stay dry and irritated. DB can block meibomian glands and cause them to swell and make less oil. As the glands become more congested, the eye becomes more irritated.

Herpetic Keratitis

In addition to comorbidities, one condition commonly associated with Demodex blepharitis is herpetic keratitis.

Demodex blepharitis is often mistaken for herpetic keratitis. The herpes simplex virus causes herpetic keratitis. Symptoms of HSV keratitis include:

Redness
Pain
Light sensitivity
Blurred vision
Watery discharge

Generally, HSV keratitis infections occur because of a reactivation of a previous infection or an infection in another part of the body, such as the mouth. If diagnosed with herpetic keratitis, the treatments will not clear the irritation caused by Demodex.

How Can You Treat Demodex Blepharitis?

Demodex can be resistant to various forms of treatment. Antibacterial, antifungal or antiviral treatments cannot kill parasitic arthropods. Additionally, they are resistant to microbial agents like povidone-iodine and alcohol. Fortunately, there are options available.

Tea Tree Oil

Tea tree oil handles the root cause of DB. Tea tree oil works as an antiparasitic agent with acaricidal properties. Terpinen-4-ol or 4-terpineol is the functional ingredient in TTO and the chemical responsible for TTO's antiviral, antibacterial, antiseptic, antiparasitic and anti-inflammatory properties.

Fortunately, there are cleansers available that can treat DB, including Cliradex towelettes and foam cleansers:

Cliradex Towelettes utilize a 4-terpineol formula. They are convenient, easy-to-use wipes that can relieve itchy, inflamed eyelids caused by Demodex.
Cliradex foam is a natural cleansing foam featuring 4-terpineol. Cliradex is designed to be used as an everyday cleaner. Use it twice a day to reduce symptoms and treat DB. It is a gentle cleanser relieves symptoms and helps maintain a clean ocular environment.

When using cleansers to reduce the Demodex population, scrub your lashes and lids where the debris and mites reside. You want to make the environment uninhabitable for the mites. Apply TTO to your cheeks, nose, forehead and eyebrows.

TTO is not only a demodicidal but also removes collarettes and cleans the lashes of any debris. Since tea tree oil can be potent and irritating, diluted TTO in cleansers is a gentle and effective alternative.

Debridement

Many doctors will suggest in-office debridement along with TTO use. Demodex eggs, collarettes, waste and proteins can build up on your lashes, thicken the lid margin and cause physical obstructions to glands and follicles. Any bacteria on or inside the Demodex can cause you to develop a biofilm on your lid margin.

In your physician's office, he or she will use a device to thoroughly clean and treat your eyes. Doctors can remove the debris and help reduce the number of mites on your skin.

Thermal Pulsation and Light Therapy

Thermal pulsation is a treatment that relies on localized heat and pressure applied to the eyelids. If DB causes blocked meibomian glands, thermal pulsation helps reduce blockage and improve drainage. Thermal pulsation can happen in-office and only lasts a few minutes.

Intense light therapy, on the other hand, delivers polychromatic light to your eyes. Demodex's chromophores absorb energy and when you apply IPL, the energy heats the mite and kills it. IPL can also decrease bacteria and reduce inflammation.

Omega-3 Supplements

Omega-3 supplements should be taken alongside other treatment methods. Omega-3 supplements can help improve dry eye and meibomian gland dysfunction. To treat inflammation caused by Demodex, consider a triglyceride-based supplement with a 3:1 EPA to DHA ratio.

Prescription Medications

DB prescription medication targets the symptoms associated with the condition. For example, a physician may prescribe anti-inflammatory medication to manage chronic inflammation or an oral doxycycline for ocular rosacea. For cosmetic redness, you may be able to take a vasoconstrictive agent to relieve redness without causing more redness when the medication wears off.

When it comes to prescription medication, you must treat the symptoms' underlying cause before you address inflammation or redness. The symptoms may not respond to medication if you do not treat the DB.

Treating Demodex Blepharitis With Cliradex Towelettes

Demodex blepharitis is an irritation of the eyes caused by Demodex mites. While Demodex are a normal part of your skin's microflora, too many can cause various issues, including infection and inflammation. If you have symptoms of Demodex blepharitis, treatment options are available. Cliradex towelettes and Cliradex foam are designed to manage symptoms of blepharitis, rosacea, dry eye and other lid disorders. Visit our shop for eyelid, lash and facial cleansers.

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