Demodex are microscopic, parasitic mites that live on the skin and hair follicles of the face including the eyelids and eyelashes (6). They feed on the oil content of sebaceous glands in the skin and the oil (meibum) in the meibomian glands of the eyes. While these mites are normally present in small numbers, an overgrowth or imbalance can be problematic and lead to a range of issues affecting the face and eyes. When their population grows excessively, they can cause conditions like chronic eyelid inflammation (blepharitis), exacerbation of ocular and facial rosacea and redness (telangiectasia) as well as worsening of dry eye disease.
How do I know if I have Demodex overgrowth?
Your optometrist or eye care provider can easily detect Demodex mites in a regular eye exam. Some symptoms of Demodex overgrowth affecting the eyes are:
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Eyelid inflammation (blepharitis): crusting on the eyelashes, eyelid swelling, redness affecting the eyelid margins. These symptoms generally do not respond to normal lid hygiene measures.
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Itchiness or burning of the eyes especially in the morning, chronic eye watering
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Dry eyes, or, worsening of dry eye symptoms especially feeling like there is something in your eye (foreign body sensation)
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Flaky or scaly skin around the eyes and lashes
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Eyelash loss (madarosis)
If you are experiencing any of the above symptoms and have already tried regular eyelid hygiene measures without any improvement, it is best to see your eye care provider for an assessment. Many of the above symptoms can also be present in a number of other ocular diseases.
How can I get rid of Demodex mites?
1. Consistent Eyelid Hygiene Maintenance
Regular eyelid hygiene measures are really the best way to prevent Demodex buildup and overgrowth (7). However, products and agents used for bacterial overgrowth are different from the ones used to control Demodex. If you have ended up with a Demodex infestation, there are a few natural methods that may help to reduce and control Demodex mites:
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Tea tree oil: Tea tree oil has been shown to have strong anti-parasitic properties and is effective at killing Demodex mites (7). It can be used to clean the eyelid area, but it must be diluted to prevent irritation: Pure tea tree oil is not safe to use around the eye area, however, eyelid sprays and wipes formulated with diluted tea tree oil work well for this. Your optometrist may be able to suggest one of these and give you more instructions on how to use them.
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Coconut Oil: Coconut oil contains lauric acid which has natural antimicrobial and anti-inflammatory properties. It can also help to soothe and hydrate irritated skin which typically comes along with blepharitis. Coconut oil has been shown to decrease mite count and symptomatic blepharitis (1). There are a few eyelid hygiene wipes available which contain coconut oil. Ask your optometrist if you are unsure.
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Hypochlorous acid: hypochlorous acid is another antiseptic agent frequently seen in eyelid hygiene products. It is natural (it’s produced by your body’s white blood cells to fight infections) (8). Hypochlorous acid has bactericidal properties (meaning it can kill bacteria). In terms of Demodex, it will not kill the mites but does shorten their life cycle so can help with maintenance of regular lid hygiene.
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Naturally derived products like aloe vera and manuka honey: Some seed oils and naturally derived products can help to reduce Demodex mite infestation. Aloe vera has been shown to do this, and also has natural antimicrobial and anti inflammatory properties. Manuka honey in particular (compared to regular honey) is another cited option, due to its higher antiparasitic and antibacterial activity. Some researchers are finding manuka honey to be equally as effective as 50% tea tree oil in controlling Demodex mite count (3). These remedies may not be sufficient enough for infestation, but could be good options for maintenance of overall lid hygiene and prevention of overgrowth (2).
Witch hazel which is quite prevalent in skincare products seems to show conflicting evidence: some studies are finding the anti-inflammatory properties helpful but others are finding it exacerbated skin inflammation (especially in Rosacea) (4). Highly concentrated alcohol (75-100%) is not very effective at killing Demodex mites (5) and not ideal to be used around the eye. -
Other plant-derived oils: there is some limited evidence that rosemary, lavender and chia seed oils can also help reduce Demodex mite infestation (9). The exact concentrations and recommendations for use are not widely known, but dilution of these agents would still be recommended before use. Asking your optometrist before applying any of these products to/around the eye area would be ideal.
Can’t I just use baby shampoo?
Although baby shampoo was once recommended regularly for eyelid area hygiene, a number of recent studies have shown that it is not only ineffective on reducing Demodex mite population, but also that it has a negative effect on tear film composition (7). This means that anyone suffering from dry eye disease should really be advised against using baby shampoo to clean around the eye area to avoid worsening of their symptoms and condition.
2. Diet, Environmental and Lifestyle Factors
Recent studies have shown possible connections between higher alcohol consumption, smoking (some studies showed no difference but others showed statistically significant differences in smokers who also abused alcohol), lower water intake, infrequent exercise, reduced bowel movements and higher pet ownership and the incidence of Demodex-related skin conditions (10, 11).
3. Maintain good general facial hygiene
Reducing oil buildup and the transfer of oils and bacteria to the eye area can help to mitigate Demodex mite populations as this will directly impact the presence of oil that they require to feed on and replicate. Therefore, simply washing your face regularly, avoiding touching the eye area with unwashed hands, changing bedding and pillowcases regularly and ensuring makeup and makeup brushes are changed or cleaned regularly can all help with this. There are many facial and eyelid cleansers available that have antimicrobial and anti-parasitic ingredients in them which may be better suited for patients suffering from chronic Demodex-based blepharitis.
4. When should I see a doctor?
Maintaining your routine eye care is a great way for your optometrist to detect certain eye conditions like Demodex before they become problematic. Outside of routine or primary eye care visits, making sure to see an eye care professional in cases of new or persistent eye health issues like chronic eye inflammation, chronic or recurring styes and/or eye or eyelid infections or frequent eruptions of ocular rosacea is beneficial in order to properly treat these conditions. In addition to at-home maintenance, your optometrist may recommend other treatments like pharmaceuticals or even certain in-office therapies like intense pulsed light (IPL), eyelid exfoliation (Blephex or ZEST) depending on the severity of your condition and clinical presentation.
Conclusion
Demodex is a very common finding during routine eye examinations and is a normal component of our facial microflora. Without proper eyelid and eyelash hygiene maintenance, the number of Demodex around the eye area can increase significantly which can cause or exacerbate secondary (and chronic) eye problems. Make sure to keep good eyelid and facial hygiene measures and see an eyecare professional when necessary in order to properly diagnose and treat Demodex related eye conditions.
References:
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Suresha, A. R., & Sadhwini, M. H. Role of demodex infestation in blepharitis and coconut oil as a treatment option-OpenAbstract. https://www.openabstract.org/abstract/role-of-demodex-infestation-in-blepharitis-and-coconut-oil-as-a-treatment-option/370
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Naeem, Rana Faisal, et al. "Canine demodicosis: Herbal and Non-Herbal Treatment Strategies." https://uniquescientificpublishers.com/wp-content/uploads/2024/herbal-medicine/459-465.pdf
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Frame, Katie, et al. "Comparing the in vitro effects of MGO™ Manuka honey and tea tree oil on ocular Demodex viability." Contact Lens and Anterior Eye 41.6 (2018): 527-530. https://www.sciencedirect.com/science/article/abs/pii/S1367048418307768
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Rademaker, M., et al. "Pharmaceutical Management of Rosacea—An Australian/New Zealand Medical Dermatology Consensus Narrative." Dermatologic Therapy 2024.1 (2024): 9678447. https://onlinelibrary.wiley.com/doi/full/10.1155/dth/9678447
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Gao, Y. Y., et al. "In vitro and in vivo killing of ocular Demodex by tea tree oil." British Journal of Ophthalmology 89.11 (2005): 1468-1473. https://bjo.bmj.com/content/89/11/1468.short
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Elston, Carly A., and Dirk M. Elston. "Demodex mites." Clinics in dermatology 32.6 (2014): 739-743. https://www.sciencedirect.com/science/article/abs/pii/S0738081X14000467
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Fromstein, Stephanie R., et al. "Demodex blepharitis: clinical perspectives." Clinical Optometry (2018): 57-63. https://www.tandfonline.com/doi/full/10.2147/OPTO.S142708#d1e765
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Mencucci, Rita, et al. "Hypochlorous acid hygiene solution in patients affected by blepharitis: a prospective randomised study." BMJ Open Ophthalmology 8.1 (2023): e001209. https://bmjophth.bmj.com/content/8/1/e001209
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Kluj, Anna, et al. "The use of phytotherapy in the fight against parasitic diseases." Annals of Parasitology 69.3/4 (2023): 91-102. https://annals-parasitology.eu/index.php/AoP/article/view/26
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Gülbaşaran, Fatmagül, et al. "Investigation of Factors Associated with Gut Microbiota in Demodex-associated Skin Conditions." Turkiye Parazitol Derg 48.3 (2024): 171-177. https://turkiyeparazitolderg.org/articles/investigation-of-factors-associated-with-gut-microbiota-in-lessemgreaterdemodexlessemgreater-associated-skin-conditions/doi/tpd.galenos.2024.93064
- Ayyildiz, T., et al. "Investigation of the effect of smoking and Schirmer test scores on ocular demodex colonization in healthy middle-aged adults." J Ocul Infect Inflamm 2.103 (2018): 2. https://www.researchgate.net/profile/Taha-Ayyildiz/publication/338039813_Journal_of_Ocular_Infection_and_Inflammation_-_Investigation_of_the_Effect_of_Smoking_and_Schirmer_Test_Scores_on_Ocular_Demodex_Colonization_in_Healthy_Middle-Aged_Adults/links/5dfb6bee299bf10bc366d915/Journal-of-Ocular-Infection-and-Inflammation-Investigation-of-the-Effect-of-Smoking-and-Schirmer-Test-Scores-on-Ocular-Demodex-Colonization-in-Healthy-Middle-Aged-Adults.pdf
Contributors:
Sarah Farrag, OD
Dr. Sarah Farrag is originally from Halifax, Nova Scotia, and is happy to be practicing optometry in her hometown. She graduated with honors from the University of Waterloo Doctor of Optometry program in June 2015. In addition to routine optometric care, Dr. Farrag also facilitates an advanced dry eye clinic offering specialty consultation and treatment for severe chronic dry eye.
