Demodex Mites and Blepharitis: What You Need to Know About Your Eyelid Health
Do you have red, inflamed, and itchy eyelids? What’s the cause and how do we stop the annoying cycle?
These symptoms are very common and typically caused by a condition called blepharitis. How do we get blepharitis? This condition can be caused by having too many of the “good” bacteria that live on and around our eyes, clogging the oil glands within our eyelids. But more often, blepharitis is caused by microscopic mites that live within our eyelash follicles, called Demodex. Up to 81% of patients who have blepharitis have an infestation of Demodex mites!
You may be wondering why you have these little creatures living in your eyelash follicles. The answer is: They are a part of the natural biome of the skin and we all have them! The role that Demodex plays on the skin is to clean up the dead skin cells and sebum. With a lifespan of only a few weeks, they burrow themselves in the follicle and crawl out at night to mate and lay their eggs. Just like head lice, there is no connection between Demodex and poor personal hygiene.
Now if these mites are normal and healthy for our skin, why do they cause such a problem for the eyes? An overpopulation of Demodex has been linked to chronic blepharitis. Under the microscope, Demodex blepharitis appears as cylindrical sleeves, known as collaretes, which coat the lashes at their base. A surplus of collarettes can make eyelids inflamed, irritated, red, crusty, sensitive, itchy, and more.
First line treatments have always included increased lid hygiene to clear away collarettes and warm compresses to open clogged oil glands. Our personal favorite is a low concentration tea tree oil foaming cleanser used once or twice daily. Tea tree oil has antimicrobial, antiviral, antiseptic, and acaricidal properties that clean the ocular surface and help it stay clean longer. While tea tree oil is helpful for the symptoms from Demodex blepharitis, it has not been shown effective in completely clearing the lids of mites. Thankfully, we have a new treatment that has great results!
On July 25, 2023, the medication Xdemvy (lotaliner) was FDA approved as the first and only medication that directly targets Demodex mites! Xdemvy is a twice daily eye drop used for 6 weeks. The active ingredient works to paralyze the nervous system of the mites resulting in eradication, not just management of symptoms. Mild side effects such as burning upon instillation or hordeolum/chalazion are common, but only occur in less than 10% of patients.
Are you ready to try the best option for relief from these common symptoms? Contact our office to schedule an appointment with Dr. Lyons or Dr. Fisher today!