Your Guide To Understanding Demodex Blepharitis

eye problems

If you frequently wake up with dried crust around your eyes, you may have a medical condition known as Demodex Blepharitis. It is a leading cause of eye irritation and occurs alongside many other commonly diagnosed eye conditions. Luckily, DB is often treatable with over-the-counter products such as Cliradex towelettes or light foam. However, it is an often-overlooked diagnosis, which leaves many people suffering while treatment is available. Understanding DB can help you identify its signs and symptoms so you can seek effective treatment.

An Overview of Blepharitis

More than 2 million cases of blepharitis are reported in the U.S. annually, making it among the most common ocular disorders. It is associated with symptoms including:

  • Blurry vision
  • Enlarged blood vessels on the eyelids
  • Redness on and around the eyelid
  • Disorders of the sebaceous glands
  • Crusting on or near eyelashes

A bacterial infection or allergic inflammation causes most cases of blepharitis. These can be managed by treating the underlying condition. However, patients that resist standard treatment are often caused by Demodex mites.

An Overview of Demodex

Demodex are ectoparasitic mites that inhabit human skin. They are a natural part of the human microflora system and generally don’t cause any problems. However, virtually all adults will have them by age 70. Despite their prevalence in the general population, Demodex can cause ocular surface disorders. Special cleansers such as Cliradex towelettes can help reduce populations before they cause symptoms.

Demodex Mites Explained

Two types of Demodex inhabit humans: D. folliculorum and D. brevis. The former inhabits lashes and lash follicles, while the latter is found inside sebaceous glands. Both mites are tiny, with the larger of the two (D. folliculorum) measuring less than half a millimeter in length.

Both species of Demodex have a similar body composition and life cycle. They contain three body segments arranged in a cylindrical shape and four pairs of legs. They feed on epithelial cells and sebum found where they live. While they live in different areas, both types of Demodex are commonly found together.

Demodex mites regurgitate their undigested food, which leads to an accumulation of waste. Additionally, they mate in hair follicles openings, leaving eggs in either sebaceous glands or follicles. The eggs hatch into larvae two weeks later, with the adults living an additional week, giving them a three-week life span.

How They Cause Demodex Blepharitis

Although Demodex mites are prevalent in adults and often do not cause any problems, that is not always the case. For example, D. brevis burrows into sebaceous glands. In the process, it can cause blockages which may lead to meibomian gland dysfunction. When D. folliculorum feed, they cause microabrasions on lashes and follicles. Over time, this can lead to hypersensitivity, allergic reactions, and inflammation.

Additionally, the regurgitated digestive enzymes of both mites can cause irritation. When it mixes with other waste, eggs, and oils, it creates the waxy buildup that is typical of Demodex Blepharitis.

eye exam

Symptoms and Signs of Demodex Blepharitis

The signs and symptoms of Demodex Blepharitis develop over time. They are directly caused by the physical effects of the mites themselves. Symptoms include:

  • Irritation of eyes and eyelids
  • Feeling as if a foreign object or substance is in the eye
  • Irregular lash growth
  • A burning or stinging sensation
  • Blurred vision that comes and goes

As mentioned earlier, the most common sign of DB is the telltale waxy buildup along lashes. These collarettes are cylindrical and wrap around individual lashes. These collarettes are made up of waste from the Demodex combined with sebum from the skin. It is a defining symptom for obtaining a diagnosis of the condition. Many patients find relief from washing them off with medicated wipes such as Cliradex towelettes.

Diagnosing Demodex Blepharitis

Many cases of blepharitis are caused by things other than Demodex, such as bacteria or allergies. Therefore it is essential to establish a correct diagnosis. The presence of collarettes is a defining characteristic of DB and can be used in forming a diagnosis.

If your doctor suspects Demodex, she will conduct a lash analysis. This microscopic evaluation can confirm or refute the presence of mites. If no mites are found, it is not DB and additional testing may be required to establish a correct diagnosis.

Standard Treatments

Several treatments can help reduce the population of Demodex mites and alleviate DB symptoms. They range from topical cleansers and antiparasitics to oral medications to in-office medical procedures.

Tea Tree Oil

The most commonly accepted standard treatment for DB involves using tea tree oil. Over-the-counter products containing TTO are available to help patients with application. For example, Cliradex foam offers antiparasitic benefits in a simple-to-apply formula. It can be used alone or with Cliradex towelettes for added benefit.

TTO works in several ways to alleviate DB symptoms. First, it is antibacterial, antiviral, and anti-inflammatory. Its main active compound, 4-terpineol, also possesses effective demodicidal properties. In this way, it effectively kills mite populations while also cleansing lashes and removing collarettes.

There is no accepted standard for the length of treatment with tea tree oil. However, many patients choose to use a TTO product for six weeks. This ensures coverage over two complete life cycles of the Demodex mite. Less frequent applications are an excellent prophylactic approach once the treatment is completed.


While its name may be less familiar, 4-terpineol is the functional ingredient of TTO. Research has shown that it is the most effective compound in TTO for treating Demodex Blepharitis. Therefore, using a product that contains 4-terpineol, such as Cliradex towelettes, is a safe, natural and effective way to manage DB.

Hypochlorous Acid

Hypochlorous acid is another cleanser that can help reduce mite overpopulation. It is a popular ingredient in many eye drops, sprays and wipes designed for ocular irritation. It is a mild, natural antiseptic that can help reduce the prevalence of symptoms.

Zocular Exfoliative Treatment

This okra-based cleanser has been shown to reduce the prevalence of Demodex mites. It is available as a cleansing foam and eyelid wipe.

Oral Medications

Patients who need additional support may need to use oral medications to manage Demodex Blepharitis symptoms. These types of treatment should be used in addition to therapy with a demodicidal agent such as Cliradex towelettes with tea tree oil.

Omega-3 Supplements

Omega-3 supplements are simple to use and readily available. Additionally, they are widely considered safe for most adults. Supplementation may help reduce inflammation and is a popular treatment for meibomian gland dysfunction and dry eye. Look for a high-quality triglyceride-based supplement containing at least two grams total of EPA and DHA.

Prescription Medications

Prescription anti-inflammatories are an effective defense against long-term symptoms such as irritation, swelling and redness accompanying Demodex Blepharitis. Additionally, since many patients with DB develop co-occurring conditions, such as ocular rosacea or MGD, they may benefit from additional treatments, such as antibiotics or vasoconstrictors. First, however, the DB must be addressed.

Additional Treatments

If oral medications and topical treatments are insufficient to reduce mite populations, you may need an in-office medical treatment. These are often very effective against DB, especially when used with continued topical cleansers such as Cliradex towelettes.

Thermal Pulsation

Thermal pulsation is a non-invasive in-office procedure that uses heat and pressure to clear clogged meibum and relieve symptoms of MGD. It is most effective when coupled with proper eyelid hygiene to reduce the likelihood of future clogs developing. You can also use warm compresses to create a similar effect at home.

blue eyes

Pulsed Light Therapy

Intense pulsed light therapy applies high-intensity polychromatic light to the affected area. It is an excellent treatment option for those needing more than a topical product. IPL is widely regarded as a safe option for DB and similar conditions such as dry eye. The OptiLight IPL is an FDA-approved device for optical treatments. Most DB patients will need four monthly treatments to see results.


DB leads to an accumulation of debris on the eyelids and lashes. This debris is a buildup of collarettes, Demodex eggs, proteins and waste. Debridement is an in-office solution that uses an exfoliation process to remove the buildup. It can also help reduce the presence of Demodex mites, making it an incredibly effective treatment option.

Risk Factors for Demodex Blepharitis

As mentioned earlier, nearly everyone will eventually have Demodex on their skin. Therefore, the most prevalent risk factor for DB is age. It is rarely seen in children, except in cases where youth have an underlying medical condition.

However, some people are more likely to develop ocular symptoms associated with Demodex. For example, people with compromised immune systems are more likely to see complications. This includes individuals with immune disorders or taking immune suppressants. Some additional risk factors include:

  • Smoking
  • Certain environmental conditions, such as sunlight exposure and temperature fluctuations
  • Drinking hot beverages and alcohol
  • Eating spicy foods
  • Stress
  • Pale complexion

Individuals at risk of DB may find routine cleansing with Cliradex towelettes helpful in managing mite populations and reducing the frequency and severity of symptoms.

Relieve Demodex Blepharitis Symptoms with Cliradex Towelettes

Demodex Blepharitis results from mites living in and around eyelids and tear ducts. It can cause irritation and discomfort. Left untreated, it may lead to more permanent consequences. Cliradex Towelettes are a simple-to-use solution that helps reduce the presence of Demodex mites and relieve symptoms.