Demodex are tiny mites found in or near hair follicles.  They are most commonly found on the face and around the eyelashes, and they are present on nearly every human being (to some extent).  They are usually about 0.3 mm long, have eight legs, and their body is covered in scales for anchoring into a hair follicle. They eat skin cells and oils which accumulate in hair follicles.  Demodex mites are mostly nocturnal and can be transferred via contact. Itchy yet?!

There are two distinct types of demodex: Demodex brevis and demodex folliculorum. Demodex folliculorum live in the hair follicles, while demodex brevis live in the sebaceous glands. Since the meibomian glands are sebaceous glands, this is problematic. We also have hair follicles on our eyelids, so the combination of this means that it’s the perfect place for demodex to live, replicate, and cause issues with our eyes. 

As stated previously, both forms of demodex feed on oil, bacteria, and dead skin that our bodies produce, and they lay eggs and replicate rather quickly.Infestation is very common, especially in the elderly,  and usually does not cause symptoms, but skin disease can develop from demodex.  The mites are considered parasitic, however most of the time no adverse symptoms are observed. Those at risk for ocular and skin problems due to demodex include those who are immunocompromised, the elderly, and people who have other inflammatory conditions. However, if you don’t fall into this category, it doesn’t mean that demodex won’t be an issue for you. Each person has their own threshold of tolerance.

The Rosacea Connection

Ocular rosacea is a chronic, inflammatory condition of the eyelids which is often associated with facial rosacea. These conditions have been postulated to be closely intertwined with demodex, and these mites may be a large contributor to these conditions. Rosacea can often lead to evaporative dry eye disease due to inflammation present in and around the meibomian glands, and this is the same for demodex. 

These conditions are so intertwined that it’s often difficult to discern which has caused which. However, the most important thing to note is that inflammation must be tackled at its heart. So, if it’s a demodex issue, we need to deal with that first. If it’s inflammation from a food you’re eating or an autoimmune condition, we need to tackle that. 

Demodex Symptoms and Signs

If your immune system is compromised or if the mite population grows uncontrollably, then symptoms can develop.  Symptoms may include:

• Red, inflamed eyelids
• Itchy eyelids
• Blepharitis
• Dandruff on eyelashes
• Itchy eyes
• Gritty eyes
• Irritated eyes
• Dry eyes

Do you notice that these symptoms are closely related to the symptoms of dry eye disease? And blepharitis? That’s because demodex can contribute to these conditions. When demodex are overabundantly present, they can begin to cause inflammation of the eyelids and of the meibomian glands. This can lead to meibomian gland dysfunction (MGD) or posterior blepharitis, anterior blepharitis (crustiness and inflammation of the front of the eyelids), and eventually dry eye disease.

Demodex Treatment: A Regimen

Using a tea tree based product on your hair, face, and eyelashes every day helps with prevention and elimination of demodex. I use  Heyedrate Handmade Organic Tea Tree Oil Soap for my hair and body, and I’ve begun to use  Heyedrate Foaming Tea Tree Face Wash on my face at night. Tea tree essential oil helps reduce eczema, dandruff, and inflamed skin, and it’s been shown to prevent/kill demodex. Click here to read more about the benefits of tea tree essential oil. If you have any skin conditions, this could help reduce the symptoms that are so bothersome.  

Dr. Jenna Zigler’s Demodex Eyelid Hygiene Regimen

• Morning Routine
• Upon awakening, rinse face with water and apply a MediViz Tea Tree Eyelid Wipe to closed eyelids
• Allow the solution to dry, as there’s no need to rinse
• Shower
• Wash the entire body with a tea tree soap bar (minimal effective ingredients, which is key!)
• Evening Routine
• Remove any makeup with oil-based makeup remover
• Apply a  warm compress to the eyes for ten minutes
• Lid massage and meibomian gland expression
• Wash face with foaming tea tree face wash
• Apply two to four sprays of Heyedrate Lid & Lash Cleanser (hypochlorous acid) to a cotton ball/round
• Wipe clean fingers in a horizontal motion across the eyelids, rubbing in the solution (alternatively, a cotton ball or round can be used)
• Allow the solution to dry, as there’s no need to rinse

Dr. Travis Zigler’s Demodex Eyelid Hygiene Regimen (Minimalist)

• Morning Routine
• Upon awakening, rinse face with water and apply a MediViz Tea Tree Eyelid Wipe to closed eyelids
• Allow the solution to dry, as there’s no need to rinse
• Shower
• Wash entire body, hair, and face withHeyedrate Tea Tree Oil Soap
• Evening Routine
• Wash face with a  Heyedrate Tea Tree Oil Soap
• Apply two to four sprays of  Heyedrate Lid & Lash Cleanser directly to closed eyelids
• Allow  Heyedrate Lid & Lash Cleanser to dry, as there’s no need to rinse

As you can see, there are a few ways to go about a morning and evening eyelid hygiene routine for keeping demodex and other skin inflammation under control. It doesn’t have to be complicated, and having the right products is key. 

The main points are, make sure you’re thoroughly  removing all makeup at the end of the day, wash your face with a  tea tree oil-based product, apply a  warm compress for symptom relief (skip this if you’re more sensitive afterward), and finish with a hypochlorous acid cleanser.

References:

https://www.ncbi.nlm.nih.gov/pubmed/30016200

https://bjo.bmj.com/content/89/11/1468