Treatment approaches to address Demodex mites on lids

Seattle-Milton Hom, OD, FAAO, discussed diagnosis and treatment of the mite Demodex at the American Academy of Optometry’s annual meeting in Seattle.

Demodex are found in 100% of patients 70+ years of age, and mite density rises in the sixth decade of life.

The clinical sequence includes:

• Clinical history, including blepharitis, dry eye, or ocular allergy;

• Slit-lamp examination, looking specifically for cylindrical dandruff;

• Microscopic confirmation of Demodex, including counting of eggs, larvae, and adults;

Patients with an overinfestation of Demodex exhibit symptoms of itch, burning, foreign body sensation, crusting, redness, and blurry vision. Some 85% of patients with Demodex also have meibomian gland dysfunction.

Cylindrical dandruff is a hallmark of Demodex. About 12.9 mites per patients were found with signs of cylindrical dandruff, in contrast to 0.35 mites per patient without.

Rosacea patients have a 7 to 8 times higher incidence of Demodex. “If you see rosacea and no Demodex, you’re missing it,” says Dr. Hom.

In-office treatments include lid scrubs, tea tree oil, and use of a bleph brush. Patients need to return for several treatments over the course of several weeks and add a home regimen. Suggest use of tea tree oil shampoo and soap to patients with an infestation of Demodex. Remember that everyone has some Demodex; we just try to control the numbers when they get out of hand.

Tips:

• Tea tree oil pads are sometimes dry on one side, so squeeze the pad so both sides are wet.

• Don’t forget children…kids can have large Demodex populations as well as adults.

• Mites are frequently mistaken for allergy.

• When epilating lashes, look for cylindrical dandruff at the base of the lash, and look for “sick” lashes (short, discolored, misdirected).

Dr. Hom’s banned list for Demodex control:

• Steroids;

• Emulsion drops;

• Restasis (cyclosporine, Allergan);

• Prostaglandins (these stimulate mite counts);

• Latisse (bimatoprost, Allergan);

• Antibiotics (useless in controlling mite population).