Understanding Demodex Blepharitis: Causes, Symptoms, and Treatment

If you’ve ever experienced itchy, red, or crusted eyelids that just won’t go away, you might be dealing with a condition called Demodex blepharitis.

What Is Demodex Blepharitis?

Demodex blepharitis is an inflammation of the eyelid margins caused by an overpopulation of Demodex mites—tiny, microscopic parasites that naturally live in human hair follicles and sebaceous (oil) glands.

While these mites are normally harmless in small numbers, when they multiply excessively, they can lead to inflammation, clogged glands, and secondary infections—resulting in blepharitis.

Common Symptoms

Demodex blepharitis often presents with subtle symptoms at first, but over time they can become chronic and significantly impact eye comfort and vision. Key symptoms include:

• Itchy eyelids, especially in the morning

• Redness and swelling of the eyelid margins

• Crusty or scaly debris at the base of the eyelashes (sometimes described as "cylindrical dandruff")

• Dry eyes or a gritty, burning sensation

• Excessive tearing or watery eyes

• Loss of eyelashes (madarosis) or misdirected lashes

• Blurred vision due to unstable tear film

If you’ve been using artificial tears with little relief or find your symptoms keep coming back, Demodex might be the culprit.

Who Is at Risk?

Demodex infestation becomes more common with age. Studies show that those who are susceptible may include:

• People over age 60 have Demodex mites

• People with rosacea or oily skin

• Those with compromised immune systems

• Contact lens wearers with poor eyelid hygiene

Treatment Options

Treating Demodex blepharitis requires both reducing the mite population and restoring healthy eyelid hygiene. Common treatments include:

1. Tea Tree Cleansers: Wipes or sprays that contain 4-Terpineol, the active component of tea tree oil that helps kill mites, can be used to clean eyelids.

2. Lid Hygiene: Daily cleaning of eyelid margins with non-toxic cleansers and use of warm compresses to unclog meibomian glands

3. Zest Eyelid Debridement: An in-office procedure that exfoliates the eyelid margins and removes debris from the lashes. A quick and comfortable treatment with immediate results.

4. Lotilaner Ophthalmic Solution (e.g., XDEMVY): A prescription medication approved by the FDA specifically for treating Demodex blepharitis by paralyzing and killing mites. In clinical trials, 50% of patients had a reduction of debris and 60% had their mites completely wiped from their eyelids.

5. IPL (Intense Pulsed Light) Therapy: Used to reduce inflammation and improve meibomian gland function, the broad-spectrum light used also helps eliminate mites and eggs.

Prevention Tips

• Wash your face and eyelids daily, especially before bed

• Avoid sharing eye makeup or face towels

• Replace mascara and eye products every 3 months

If you’re experiencing persistent eyelid irritation, dry eyes, or vision changes that don’t improve with over-the-counter drops, it’s time to get checked for Demodex blepharitis. Early diagnosis and targeted treatment can dramatically improve your eye health and comfort.

Demodex blepharitis is more common than many realize (affecting 25 million Americans) and often goes undiagnosed. With the right approach, it’s manageable and treatable. Don’t suffer in silence; talk to your optometrist if you suspect you might have this condition.

Need help managing your eye symptoms? Call us at 725-220-2020 to book an appointment with our eye care team today.