You see them year after year in your chair: persistent cylindrical dandruff (CD), red lid margins, and eyelash distention. You've prescribed lid scrubs with baby shampoo, warm compresses, and even steroid/antibiotic combo drops, but nothing seems to resolve the condition. If this is the case, it's likely you are dealing with demodex blepharitis. Research indicates that demodex is present in all, or at least most, cases of anterior blepharitis.1 Studies have shown that cylindrical dandruff is pathognomic for demodex,1,2 while conventional wisdom holds that blepharitis is staphylococcal or sebhorreic.3 This represents a paradigm shift and requires a different approach to treatment.
While the aforementioned conventional treatment options can clean up the mess and decrease some signs of blepharitis, none are toxic to demodex, and the condition will persist.4 While new treatments under consideration include topical or oral ivermectin and Greenbug for People cedar oil, a new treatment paradigm is taking shape, and tea tree oil is at the heart of it.
Related: Diagnosing demodex
Left untreated, or poorly managed, chronic blepharitis has many adverse effects—it causes allergy, inflammation, lash loss and misdirection, telangiectasia, and may play a role in meibomian gland dysfunction.5
Demodex blepharitis is nothing new. Interest has waxed and waned over the years, and a landmark paper on demodex was produced by an ophthalmologist in 1967.6 He lamented the fact that he had overlooked demodex for over 30 years! Most eyecare practitioners have overlooked demodex as well.