Demodex Folliculorum is an ectoparasite which belongs to the class Arachnida (sub class: Acari). It lives on the surface of the human body and is mostly found on the face, cheeks, forehead,nose and eyelids. Demodex often hide in the deep ducts of the sebaceous glands since active sebum excretions provide a favorable habitat for breeding and
nourishment. Moreover, they could also be found in other parts such as chest,feet and ears. As the human grows older, the colonization of the demodex increases. At age of 70 colonization reach its maximum. Demodex Folliculorum symptoms are similar to common blepharitis for example: ocular tickling and itching, crawling sensation, crusting and redness of the lid margin, and blurry vision. Suspicions of a Demodex infestation should be aroused by the loss of lashes and/or cylindrical dandruff around the base of the eyelashes during a slit lamp evaluation. Demodex mites can be detected by examining the eyelashes with a microscope.
Take a closer look to a demodex mite in the following video, the mites vary in size from 0.1 mm to 0.4 mm long :
There are three different main types of blepharitis
- Anterior blepharitis affects the outside front part of the eyelid, where the eyelashes are located. The two most plausible causes of anterior blepharitis are bacteria (Staphylococcus) and scalp dandruff.
- Posterior blepharitis affects the part of the eyelid that makes contact with the eye and is caused by problems with the oil (meibomian) glands in this part of the eyelid. Two skin disorders can cause this form of blepharitis: Acne Rosacea, which leads to red and inflamed skin, and scalp dandruff (seborrhoeic dermatitis)
- Mixed blepharitis, affects the entire lid margin.
Demodex Blepharitis infestation can lead to eye irritation, burning and itching of the eyes, erythematous eyelid margins with typical cylindrical dandruff, dry eye and visual complaints such as blurred vision.
The severity of the eye lid margin disease not only corresponds with an increased number of Demodex. But it is also dependant on the number of bacillus Oleronius suggesting a link
between Demodex and bacillus Oleronius and the severity of blepharitis. The mite’s digestive system is so efficient and results in so little waste that they have no excretory anus. Bacillus
Oleronius has been detected inside Demodex mites, suggesting that this bacterium could aid digestion in the mite .
Scientists have found that the bacillus Oleronius bacteria parasite may act as a carrier, which most probably functions as a co-pathogen in the development of severe forms of blepharitis. The Demodex mite and/or its secretions have been suggested as a causative agent for the inflammation seen in blepharitis. Demodex mites can cause blepharitis by carrying bacteria on their surface including Streptococci and Staphylococci. Moreover,these bacteria produce proteins that can activate neutrophils. These netrophils are responsible for the production of inflammatory cytokines implicated in the induction of Rosacea .
Associated risk factors
There are a large number of risk factors that may be associated with an increased infestation with Demodex Folliculorum. It is not clear, if Demodex infestation is related to gender.
- Stress and emotion
- Climate: (warmth, humidity, sun and wind)
- Certain Drinks and food
- Coffee and tea
- Hot liquids, spicy food (e.g. chili, curry, pepper)
- Pets (dogs often suffer from mites)
- Perfume, after shave.
- Peeling products
- Soap & Sun oil.
- Sinus and allergic conditions (e.g. the bacillus Oleronius)
Poor ocular hygiene in combination with increasing age may also be associated with an increase in Demodex count as a result of blocked oil glands which prevent normal sebum secretion resulting in increased infestation.Treatment with topical steroids particularly long term use of these drugs may also result in an increase in the number of Demodex.
The detection rate of Demodex can be affected by many factors :
- Area of examination
- Time of examination.
- The use of make-up (reduce the likelihood of Demodex carriage in young adults)
- Age (higher prevalence of Demodex mites in older women )
- Usage of Creams
- Redness of the lid margins
- Lashes with cylindrical dandruff
- Meibomian gland dysfunction (MGD)
- Swollen eyelids
- Blepharitis or Meibomitis
- Conjunctival inflammation (Conjunctivitis)
- Nodular scaring
- Eyelash loss (madarosis)
Facial skin manifestations:
- Hair loss
- Itchy eyebrows, scalp and face
- Crawling sensation
- Swollen nose
- Oilier skin than normal
- Enlarged facial pores
- Clogged pores
- Acne, cysts, and pustules
- Rosacea or facial flushing
The main symptoms of infestation are tickling and itching, crawling sensation on the face and in the scalp in the evening, burning, foreign body sensation, crusting and redness of the lid margin, blurry vision and failed response to dry eye treatments and blepharitis. Itching during the night and early morning on the lower nose, eyebrows and eyelashes and irritation is common with these mites because of their aversion to light. Demodex mites are active at night and come out onto the surface to mate and to lay their eggs on the lashes. They subsequently crawl back into the follicle in the morning, causing the patient to itch. What makes the diagnosis of Demodex difficult is that some patients will have “a lot of Demodex” without symptoms . All of these conditions are typically bilateral and chronic or relapsing.
Demodex Folliculorum blepharitis treatment goals include: eradicating the adult mites and their offspring, prevention of further mating, avoiding re-infestation and alleviating the patient’s symptoms. Understanding the mite’s life cycle and habits helps design a logical treatment plan.
Several options are available for the treatment of Demodex Folliculorum. These include treatment with topical and systemic anti-inflammatory and antibacterial medications, mercurial ointment, sulphur ointment, camphorated oil, antibiotics, as well as anti mycotic drugs. As a topical treatment, tea tree oil is the preferred medication in combination with lid hygiene as evidence shows that it reduces the numbers of Demodex, is safe and has minimal side effects. It is also the only treatment that an Optometrist would be able to provide within the remit of their practice.
Tea tree oil
Demodex Folliculorum is susceptible to tea tree oil. Tea tree oil is a natural oil distilled from the leaf of Melaleuca alternifolia. At home, a twice daily lid scrub with 5 % tea tree oil is followed by a massage of the eyelids. This prevents mating and therefore prevents an re-infestation from occurring around the eyes.
The best tea oil available product in the market is Cliradex Eyelid, Eyelash and Facial Cleansing Towelettes a patented formulation with 4-Terpineol, the key ingredient of tea tree oil. Cliradex is scientifically shown to be safe and effective to control lid margin diseases. The killing mites effectiveness of Cliradex formulation has been published in over a dozen peer-reviewed papers and studies.
How to apply :
- Wash your hands
- Wash your face
- Tear open the packet and unfold the towelette
- Close the eye, gently clean the eyelid and surrounding facial area, no squinting is required
- Avoid towelette getting inside of the eye as it might sting
- Flip the towelette over, and repeat for the other eye
Great Tips :
- Cut each towelette package in half and save for later use
- Be careful not to touch your eye with the wipes, as it will sting a bit
As an alternative, Blepharitis Wiki suggests the We Love Eyes: Tea Tree Eyelid Foaming Cleanser – Vegan. Use this multi-purpose tea tree eyelid foaming cleanser to soothe your demodex symptoms by washing away dirt, allergens and makeup residue. The tea tree oil in eyelid foaming cleanser attacks bacteria and demodex Folliculorum mites to combat red, itchy, irritated eyelid symptoms. Plus, it’s safe to use with lash extensions.
Lid Warming + Massage
It is scientifically found a strong positive relation between ocular surface comfort and Demodex counts despite age. They concluded that good eyelid hygiene decreases the prevalence of Demodex Folliculorum and helps to improve ocular discomfort in all ages. Eye lid cleaning procedures and a warm compress and vertical eyelid massage works to both melt the thick wax in the meibum and loosen any debris on the eyelid margin and eyelashes. There are several devices which can be used to warm the eye lids. The success of this treatment appears to be multi-factorial and includes thickening and stabilization of the meibomian lipid layer as well as the reducing bacterial colonization, which has been proven to be effective in diminishing the symptoms.
The easiest way to warm your eyelids is via Eye Mask like Oasis REST & RELIEF Eye Mask which adjunct Hot Therapy for the relief of Demodex Folliculorum Symptoms. Temperature retaining beads that conform to the body in a soft knit cloth mask for maximum comfort. Put it on a clean plate and then in the microwave for 15 seconds. The mask will be warm for 10 minutes, no water is needed. It is much simpler and easier than common hot compresses.
The management involves these steps:
- Clean your hands ( eye mask should also be clean)
- Apply warm eye mask for 10 minutes
- Gently massage your closed eyes by rolling your little finger in a circular motion
- Take a cotton wool bud and, with your eyes shut, gently roll it downwards on the upper eyelid towards the lashes and edges of the eyelids – this helps to push the melted oil out of the glands, but you won’t be able to see the tiny droplets
- Repeat the process along the whole width of the upper and lower eyelids
There is no special diet to prevent or stop Demodex. On the other hand, it is well known that anti-inflammatory food improves eye health. Recent researches shown that Omega-3 fatty acids which are included in the salmon, oysters, herring and mackerel increase the tear production and the quality of the tear film. Supplements rich in omega-3 fatty acids which have been shown to improve several ocular disorders, seems to help also against demodex.
Health Eye-Lid Guidelines
There are some simple rules that help improving treatments efficiency :
- Always protect your face ! Do not touch it with anything dirty
- Wash pillow covers and sheets more often and in higher temperature ( if possible discard them and buy new ones )
- Avoid makeup during treatment and discard old makeup
- Discard your spouse
- Demodex F. can travel easily from one person to other. Make sure everyone in your household as checked as well. This includes pets as well . Dogs are prone to mites .
Mites can be responsible for many ocular or facial disorders and inflammations like blepharitis , MGD and rosacea. Our suggested treatments and especially tea oil scrub eradicate mites in a few months. Improving your everyday hygiene contributes to get rid of the mites even faster. Last but not least, if treatment is combined with anti-inflammatory diet including omega-3 the efficiency rises!