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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.
Best medications for Demodex blepharitis
| Drug name | Learn more | See SingleCare price |
|---|---|---|
| Xdemvy | xdemvy details | Get free coupon |
| OcuSoft Lid Scrub Foaming | ocusoft-lid-scrub-foaming details | Get free coupon |
| Ocusoft Hypochlor | ocusoft-hypochlor details | Get free coupon |
| Soolantra | soolantra details | Get free coupon |
| Ivermectin | ivermectin details | Get free coupon |
| Elimite | elimite details | Get free coupon |
| Permethrin | permethrin details | Get free coupon |
| Metrogel | metrogel details | Get free coupon |
| Metronidazole | metronidazole details | Get free coupon |
Common side effects of Demodex blepharitis medicine
You may experience some side effects with your DB treatment, such as burning, itching, redness, eye pain, dryness, and eye irritation. Oral antibiotics used to treat Demodex blepharitis may cause nausea, vomiting, diarrhea, constipation, and upset stomach.This isn’t a complete list of possible side effects, so you should talk to your healthcare provider about others that you might experience based on your course of treatment.
If any of these side effects are too uncomfortable for you, work with your doctor to find an alternative method—there are many to try. Some courses of treatment involve more than one medication or a combination of medication and lifestyle changes.
Before trying different treatments, talk to your healthcare provider about other medications you’re taking and the side effects and potential drug interactions that you could experience.
Best home remedies for Demodex blepharitis
Most over-the-counter treatments for DB include tea tree oil, which has antimicrobial, antifungal, antiseptic, and antiviral properties that kill the skin mites causing the condition. Some people experience some mild side effects from tea tree oil, like burning or stinging.There are some methods of treating DB that require more research and study. For instance, it’s not clear whether Vaseline (petroleum jelly) on its own can kill Demodex mites, but petroleum jelly sometimes is used in treatments for the condition. It’s best to talk to your healthcare provider about whether this should be a part of your care plan.
To prevent the development of DB or prevent its return once treated, you can make a few lifestyle changes:
- Reduce exposure to makeup
- Avoid using lotions or moisturizers that irritate your eyes or skin
- Avoid exposure to allergy triggers, including seasonal allergies and animals
- Practice good eye and skin hygiene by washing your face daily with a gentle, non-irritating cleanser
- Keep your bedding, clothing, and soft furnishings as clean as possible because Demodex mites can live in bedding and fabrics for hours to days
- Demodex mites can be passed from person to person, and avoiding close facial contact with those who have Demodex blepharitis until the condition is resolved can help prevent its spread
Frequently asked questions about Demodex blepharitis treatment
What is the fastest way to get rid of Demodex?
The fastest way to get rid of Demodex wipes depends on your medical history, allergies, and other medications that you might be taking. Your healthcare provider may prescribe a treatment, such as Xdemvy (lotilaner ophthalmic solution), or recommend an over-the-counter treatment, such as OCuSOFT Lid Scrub Foaming Cleanser, creams or oral antibiotics. Talk with your doctor about the best and fastest options for you.What antibiotic ointment is good for Demodex mites?
Metrogel (metronidazole) is an antibiotic cream that is sometimes prescribed to treat Demodex blepharitis by targeting the mites that cause the irritation. Metronidazole can interact negatively with other drugs, so it’s important to tell your healthcare provider about other medications you’re taking. There are also over-the-counter wipes and cleansers available that can be used to get rid of Demodex mites.What over-the-counter medicine kills Demodex?
Over-the-counter treatments for Demodex blepharitis are often eyelid cleansers. OCuSOFT Oust and Cliradex, both of which are available as moist wipes and foam cleansers, are popular options that can often be found at your local drugstore or supermarket. Most over-the-counter treatments, like OCuSOFT Lid Scrub Foaming Cleanser, include tea tree oil, which kills the mites that cause DB.Sources
- Clinical diagnosis and management of Demodex blepharitis: the Demodex Expert Panel on Treatment and Eyelid Health (DEPTH), Weill Cornell Medical College (2023)
- Blepharitis, Johns Hopkins Medicine (2023)
- Pathogenic role of Demodex mites in blepharitis, Current Opinion in Allergy and Clinical Immunology (2010)
- Demodex (face mites), Cleveland Clinic (2022)
- Demodex blepharitis: clinical perspectives, Clinical Optometry (2018)
- Efficacy of topical ivermectin 1% in the treatment of Demodex blepharitis, Cornea (2021)
- Permethrin cream for the treatment of Demodex blepharitis, Cornea (2019)
- Topical administration of metronidazole gel as an effective therapy alternative in chronic Demodex blepharitis--a case report, Klinische Monatsblätter für Augenheilkunde (1998)
- Are tiny mites causing your blepharitis?, American Academy of Ophthalmology (2022)
- Demodex blepharitis: A comprehensive review of the disease, current management, and emerging therapies, Eye & Contact Lens (2023)
- Human Demodex mite: The versatile mite of dermatological importance, Indian Journal of Dermatology (2014)
- Treatment of ocular Demodex infestation with topical ivermectin cream, American Journal of Ophthalmology Case Reports (2022)
- Demodex Blepharitis Treatment Study (DBTS), National Eye Institute (2017)
- Tea tree oil for Demodex blepharitis, Cochrane Library (2020)