Do you ever have itchy, red, irritated, gritty feeling eyes that just don’t seem to get go away? Recently, we have been finding a high incidence of Blepharitis (inflammation of the eyelids) is caused by Demodex Parasite infestation. These little mites are found at the roots of the eyelashes and can cause a whole spectrum of eye conditions from slight irritation and dandruff-like material on the eyelashes (Fig. 2A), to more serious scarring and eye inflammation (Fig. 2B-D), even turning in of the eyelashes which constantly rub and irritate the eye.

There are 2 main species of this parasite. Demodex folliculorum (Fig. 1A), tends to be clustered to the root of the lashes (Fig. 1C), while demodex brevis (Fig. 1B), tends to present individually in the oil glands of the eyelid margin.

Demodex mites are present on most humans in small quantities, and on pets. People that allow pets to sleep in their beds often acquire these bugs from them. They can also be spread on towels and linens from person to person. As they are on a nocturnal cycle, they will come out of the lash roots while you are sleeping to mate and reproduce on your skin, then burrow into the hair follicles by morning.

In our office we can sample the eyelashes if we see suspicious signs of these parasites, and directly visualize them under a microscope. If present we can initiate treatment to eradicate them and prevent progression and spreading of the disease to others.

To treat the infestation, office lid scrub with 50% tea tree oil (TTO) combined with daily lid hygiene with 5% TTO ointment and shampoo can eradicate ocular demodex. Patients receiving 50% TTO lid scrub show dramatic improvements in symptoms, eye inflammation, tear film stability, and better vision. The demodex count usually drops to zero in 4 weeks without recurrence in a majority of cases.