Demodex Blepharitis Treatments and Medications

Demodex blepharitis (DB) is a condition that affects the eyelids along the margin where eyelashes grow. It is a type of ocular surface disease caused by very small, invisible mites.

Despite being very common—an estimated 25 million people in the U.S. experience the condition—demodex blepharitis is very often misdiagnosed because it can resemble other types of eye infections.

Common symptoms of Demodex blepharitis include inflammation, itching, redness, a crusty/waxy buildup at the edge of the eyelid and base of the eyelashes (known as collarettes or sometimes as “crusties”), and eyelashes that grow up instead of down. The presence of collarettes is often used to diagnose the condition.

DB requires diagnosis by a healthcare provider. Your provider will perform a visual and physical examination of your eyelids. They may also ask you about makeup or skincare products you use. In some cases, a sample of your eyelashes may be taken for further examination.

Demodex blepharitis treatment options

The good news is that Demodex blepharitis is treatable, and there are many options available, both over-the-counter and by prescription. Some treatments are eye drops, usually administered once or twice per day for several weeks or months, depending on the severity of the condition and how symptoms respond. Others are moist cleansing wipes for daily use. Your healthcare provider may also talk to you about foaming cleansers, sprays, creams, gels, and oral antibiotics that can be used at home.

Some lifestyle changes and home remedies can prevent Demodex blepharitis, like avoiding eye irritants, managing seasonal allergies, and practicing good ocular hygiene.

The best way to get rid of Demodex blepharitis is by seeing your healthcare provider and working together to pick the right treatment for you.

In-office treatments

Patients with DB may be recommended an in-office procedure to remove debris caused by the condition, eradicate the mites, or alleviate symptoms. Your healthcare provider might talk to you about using:

• Intense pulsed light (IPL): Light energy is applied to the skin to help remove “crusties” (collarettes) and reduce mite density.

• Microblepharoexfoliation: A sponge soaked in the cleanser is used to gently exfoliate the skin, remove biofilm, and clear the crusties that build up as a result of DB. Some might find this treatment mildly uncomfortable.

• Thermal pulsation: Controlled heat and pulsation are applied to the eyelids to help get rid of eye obstructions and improve oil secretions in the affected area.

• Thermal expression: Controlled heat and expressive force are applied to the skin.

Demodex blepharitis medications

There are several types of drugs commonly used to treat Demodex blepharitis: eye drops, eyelid washes, antiparasitics, insecticides, topical antibiotics (creams or gels), and oral antibiotics.

Patients with DB should consult their healthcare provider for more information about each treatment option. Your healthcare provider may recommend using a combination of treatments.

Antiparasitic eye drops

Xdemvy (lotilaner ophthalmic solution) is a twice-daily eye drop treatment used to treat Demodex blepharitis and is available by prescription only. It’s currently the only FDA-approved treatment for Demodex blepharitis. Xdemvy kills the mites that cause DB. The most common side effect of this treatment is a burning or stinging sensation.

Eyelid washes

According to the American Academy of Ophthalmology, over-the-counter medications and cleansers are the first line of treatment for eye conditions like Demodex blepharitis.

Eyelid washes, such as OCuSOFT Lid Scrub Foaming Cleanser, OCuSOFT Oust Demodex Cleanser (also available as a moist wipe), and Cliradex (available as towelettes and foaming cleansers) are common over-the-counter treatments for Demodex blepharitis.

Cliradex wipes and cleansers contain terpinen-4-ol (T4O), the most active ingredient of tea tree oil, which targets the Demodex mites and helps relieve symptoms of dryness and inflammation. OCuSOFT Oust wipes also contain tea tree oil. Using this kind of treatment, you might experience an itching or burning sensation in your eyes or skin irritation. The use of tea tree oil can cause contact dermatitis, eye irritation, allergic reactions, and epithelial cell toxicity.

OCuSOFT also makes HypoChlor spray. On its own, this spray won’t eliminate Demodex mites, but it can relieve uncomfortable symptoms of DB.

PROCUTiN is an over-the-counter topical spray that can be used to kill Demodex mites. It’s used nightly for three to four months.

Antiparasitic creams

Topical ivermectin 1% cream, such as Soolantra, applied once per week for 15 minutes in addition to practicing good eye hygiene can reduce swelling and redness, ocular surface staining, and debris that often come with Demodex blepharitis. It has also been shown to reduce the density of Demodex mites. Patients using ivermectin cream may experience mild eye and skin irritation. It can also have negative interactions with other drugs, so tell your doctor about other medications you’re taking.

Insecticides

Elimite (permethrin) cream has been used to reduce the density of Demodex mites on the skin and alleviate the symptoms of the condition with few side effects.

Topical antibiotics

Your healthcare provider may prescribe a topical antibiotic treatment (a cream or a gel) to treat your DB. Metrogel (metronidazole) is a topical treatment for Demodex blepharitis used to treat the signs and symptoms of the condition by reducing the density of mites causing the irritation. Metronidazole can have adverse drug interactions, so it’s important to talk to your doctor about other medications you’re taking.

Oral antibiotics

Metronidazole and ivermectin can also be taken as oral antibiotics for the treatment of Demodex blepharitis. Side effects include nausea and vomiting, diarrhea, upset stomach, constipation, headache, or a metallic taste in the mouth.

What is the best medication for Demodex blepharitis?

The best medication to treat your demodex blepharitis depends on the severity of your condition, your medical history, and the other medications you may be taking (since some may interact negatively with DB treatments). It may also depend on the type of medication you’re comfortable using. For example, you might prefer a cream instead of eye drops.

Work with your healthcare provider to pick the right treatment—or treatments—for you.

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Best medications for Demodex blepharitis