Demodex Mites And Chronic Dry Eye

Do your eyes constantly feel dry, irritated, and downright uncomfortable?
You could be among the millions suffering from a chronic dry eye condition related to Demodex mites. These microscopic eight-legged creatures naturally live on everyone’s skin, including around the eyes and eyelids. But in some people, an overpopulation of these mites can trigger inflammation that exacerbates dry eye symptoms.

If you’ve been struggling with unexplained dry eye issues, it’s worth investigating whether Demodex mites could be the root cause.
Here’s a deep dive into recognising the symptoms of a demodex infestation, understanding how these mites contribute to dry eye disease, and exploring effective treatment options for controlling these pests.

What Are The Symptoms of Demodex Blepharitis?

People with Demodex Blepharitis or an overpopulation of these mites living around their eyes tend to experience a cluster of telltale symptoms, including:

• Burning, stinging, or gritty feeling in the eyes, especially later in the day
• Excessive tearing or watery eyes that can’t be explained by allergies
• Red, inflamed eyelids and skin around the eyes
• Crusty dandruff-like buildup along the lashes and lid margins, these often appear as collarettes
• Eyes that feel extremely light sensitive or like they’re “squinting.”
• Periods of blurred vision that comes and goes

Many people struggle for years with dry eye symptoms without realising that Demodex mites are a major contributing factor.

How Do Demodex Mites Cause Dry Eye?

So how exactly do these microscopic bugs create such miserable dry eye symptoms? Demodex mites feed on skin oils and cells, taking up residence in and around the hair follicles of the eyelashes. Their waste products, eggs, and dead mites build up along the lid margins, creating debris and bacterial biofilm that can clog delicate oil glands.

When oil can’t be properly secreted to reinforce the eye’s tear film, dry spots develop quickly. This oily tear film is key for preventing premature evaporation of the watery tears that keep eyes lubricated and comfortable.
The resulting inflammation also contributes to further surface eye irritation, redness, and that gritty, dry eye feeling.

The Demodex Mite Life Cycle

Understanding the Demodex life cycle is important for effective treatment. These mites go through egg, larva, nymph, and adult stages during a 14-21-day life cycle. They are most active at night when they leave hair follicles to mate and lay new eggs on the skin’s surface.

This is why the best time for demodex treatments is in the evening before bedtime. Treating at night disrupts the mites when they are out and active, making it easier to kill them off. However, their rapid life cycle means any survivors can quickly repopulate, so continuous treatment over weeks or months is required.

Efficacious Treatments for Demodex Dry Eye

If your optometrist determines through eyelash sampling or microscopic evaluation that you have a high demodex mite load, they will likely recommend one or more Demodex treatment approaches:

1. Tea Tree Oil Eyelid Wipes and Scrubs

Tea tree oil solutions have antimicrobial and antiparasitic properties that will help kill off mites. Tea tree oil will kill some mites near the surface, destroy the collarettes that they produce and cause buried mites to come to the surface where they are more vulnerable.

While tea tree oil is effective against mites, using tea tree essential oils will sting on application and can be Cytotoxic to our own cells, causing inflammation and worsening symptoms in some patients.

Using a tea tree oil eyelid wipe or scrub daily before bed to clean along the lid margins helps reduce mite populations over time. OcuSoft Oust Foam is an example of a Tea Tree oil solution which is particularly effective against Blepharitis primarily caused by Demodex Mites.

2. Hypochlorous Acid Lid Hygiene Sprays

Hypochlorous acid is naturally produced by our own immune system as an antimicrobial agent. It is gentle on the eyes, it doesn’t sting and it isn’t cytotoxic to our cells.

Disinfecting lid sprays and cleansing foam products containing hypochlorous acid have a mite-killing antiseptic effect and anti-inflammatory effects to help reduce symptoms.
Spraying or applying these formulas along the lash lines before bedtime can clear out mites and their debris. These solutions have a specific odour and can smell a little like chlorinated pool water. Ocusoft Hypochlor Spray and Avenova are examples of Hypochlorous Acid-based solutions.

We usually recommend Ocusoft Hypochlor Foam because it represents better value, having a much more generous expiry period after opening.

3. Manuka Honey Solutions

Manuka Honey based solutions have been shown to be as effective as 50% Tea Tree oil against Demodex in one study but more research is needed in this area. Manuka Honey stings on application and is less effective than tea tree oil against Demodex but very effective against other forms of Blepharitis. It is not cytotoxic and less likely to cause inflammation in our eyelids.

People often report that it causes a good sting, because they know their eyes will feel better afterwards. Manuka Honey solutions are available as a gel (Optimel Forte) which stings more but is more effective and as drops (Optimel Drops) which sting less and are easier to apply.

4. Oral Anti-Parasitics for Demodex

In cases of severe, persistent demodex overpopulation, some doctors prescribe oral antiparasitic medications. Ivermectin in pill form has proven effective, as has taking weekly doses of oral tea tree oil supplements for several months to control mite levels.

5. Professional Demodex Treatments

Some eye clinics offer intensive in-office treatments specifically for Demodex using the Oust Demodex Cleanser Swabstix or a hand-held electric spin brush called BlephEx.

Oust Demodex Cleanser Swabstix utilises a pre-packaged solution of tea tree oil, sea buckthorn and coconut oil in one applicator which is applied to the eyebrow, eyelid margin and the top of the eyelid while your eyes are closed.
BlephEx is a medical-grade microbial brush dipped in a foam solution which deeply cleanses underneath the eyelashes and lid margins to disrupt mite populations. Multiple treatments are often required for full effectiveness with both of these treatments.

6. Anti-Inflammatory Dry Eye Drops

Along with direct mite-killing treatments, using anti-inflammatory or immunomodulator eye drops can provide symptom relief. Prescription options like Ikervis, Cequa or corticosteroid drops reduce inflammation and calm the irritated ocular surface when used alongside demodex treatments.

Dry eye correlated with Demodex mites can prove obstinate and challenging to fully mitigate. Owing to their rapid life cycle, mite populations can swiftly regenerate; hence, aggressive treatment combined with consistent daily eyelid hygiene is imperative.
Prolonged treatment is often necessary to effectively manage Demodex numbers.

Do not be disheartened—with perseverance and consistency, these pests can be managed. If you are contending with dry, irritated eyes that fail to find sustained relief from artificial tear usage alone, it is advisable to seek evaluation for a potential demodex infestation.

Converging established mite-killing methods with dry eye therapy provides the most promising prospect of attaining enduring comfort and relief.