You might not be aware that an entire colony of mites lives on the skin, which can’t be seen by the naked eye. Although this is completely typical, sometimes these microscopic mites can cause redness, itching, and swelling in the eyelids. Here’s what to know about a common form of this inflammation, known as Demodex blepharitis.
Blepharitis, or inflammation of the eyelid, is a very common condition. In fact, some experts estimate that between 37% to 47% of people who visit their eye care professional for an examination have some evidence of blepharitis.
In many cases, this is a result of Demodex mites, which live in the lash follicles as well as the sebaceous and meibomian glands. These are the oil-producing glands along the upper and lower eyelids.
Experts stress that having these mites is due to a lack of proper hygiene practices. According to the American Academy of Ophthalmology (AAO), these tiny creatures known as Demodex mites are actually just part of your skin’s healthy microbiome. However, an overgrowth or infestation of these mites can cause symptoms, such as:
- swollen eyelids
- eye redness
- greasy eyelids
- itching
- crust forming on the eyelashes and the corners of the eyes
- dry eye
- loss of lashes
To some degree, the symptoms may also depend on the location of the affected glands or follicles. According to research, this condition can often interfere with people’s ability to wear contact lenses comfortably.
People at greater risk for Demodex blepharitis include those with rosacea and diabetes. The risk can also increase as a person ages.
While Demodex mites may not be responsible for every single case of blepharitis, they are likely responsible for over two-thirds of all cases in the United States, according to some estimates.
One common sign of Demodex blepharitis is a crusty or flaky buildup along the eyelashes. However, it’s important to schedule an appointment with your doctor to receive an accurate diagnosis.
When testing you for Demodex blepharitis, your eye doctor will likely use a slit lamp (essentially a very bright light and a microscope) to look at your closed eyes. They might look for evidence of waxy or crusty buildup at the base of the eyelashes. These waxy, cylindrical crusts, also known as collarettes, contain waste material from the mites. Some say it resembles “eyelash dandruff.” This evidence can help your doctor make the appropriate diagnosis.
In the past, treatment options for Demodex blepharitis were fairly limited.
Eye doctors often recommend using eyelid scrubs or gentle cleansers on a daily basis, as well as trying warm, moist compresses to temporarily relieve symptoms. Some people also experienced improvement from applying an over-the-counter topical medication containing a low concentration of tea tree oil or hypochlorous acid.
Eye doctors may also suggest an off-label use of other treatments, such as anti-parasitic medication. This means that the Food and Drug Administration (FDA) has not officially approved the medication for the treatment of the condition. However, the medication can still be used to treat the symptoms. For example, a 2021 study found that applying a 1% ivermectin cream for 15 minutes once a week, along with eyelid hygiene (using a cleanser), was effective at managing this condition.
However, a new treatment specifically approved for the treatment of Demodex blepharitis was approved in 2023 called lotilaner (Xdemvy). These prescription eye drops contain an anti-parasitic agent that can help with both short-term and long-term management of this condition, as well as alleviate symptoms of dry eye syndrome.
Side effects may include burning or stinging after applying the medication.
If your eyelids are swollen, red, or itchy, you could have Demodex blepharitis. Applying warm compresses, using eyelid scrubs, or treating your eyes with tea tree oil may help with symptoms. However, if they persist, see your doctor. They can determine whether or not you actually have Demodex blepharitis and recommend the best treatment for you.