Blepharitis and Demodex
Demodex mites are tiny micro-organisms that are found on almost everyone. The odds are, if you pluck an eyelash from an adult and look under a microscope, you will find Demodex. In more than two thirds of patients with blepharitis, Demodex mites are felt to be a major cause of blepharitis symptoms. Demodex blepharitis is seen in almost 60% of patients coming in for cataract surgery or for dry eyes. While Demodex becomes more common with age, it can affect any person regardless of age, gender, or ethnicity.
In some people however, Demodex mites flourish and overgrow more than in other people. This does NOT mean that these people have poor hygiene or dirty eyelids. Some individuals, based on their body chemistry or genetics, may be predisposed to have overgrowth of Demodex.
Demodex blepharitis is diagnosed by an eye exam. The eye doctor uses high magnification to see typical waxy cuff-like deposits at the base of the individual eyelashes. These deposits are called “collarettes” and are definite evidence of Demodex.
Xdemvy (Lotilaner 0.25%) eye drops directly treat Demodex. One drop is instilled in each eye, twice a day, for 6 weeks. This treatment may need to be repeated, but is very effective. It is also important, however, to clean the lid rims every day, long term, to keep the blepharitis controlled. The most effective products for lid rim cleaning are those with tea tree oil which helps keep Demodex controlled. Various formulations including lid scrub pads with tea tree oil, lid foam or gel cleansers with tea tree oil, etc. can be used along the lower and upper lids. Some people are sensitive to tea tree oil and cannot tolerate it. In this case lid scrub pads without tea tree oil can be used. Hypochlorous acid spray (harmless if it gets in the eye despite the “acid” in its name) is also helpful. Hypochlorous acid is sprayed on closed lids and allowed to dry (do not rinse off). This is especially beneficial if a patient cannot tolerate tea tree oil. Even if you are treated with Xdemvy, you should continue daily cleaning of the lid rim/lashline with one of the above products long term.
