Dr Morris' Demodex Treatment Information

Demodex Blepharitis is a particularly nasty type of blepharitis that is both stubborn to clear and recurrent.  Itchy lids, morning crust and a feeling like you want to pull on your lashes are all common demodex blepharitis symptoms.

I am making the assumption with this post that your eye care professional has made this diagnosis.   Demodex blepharitis does not mean bad blepharitis but rather a specific type with inflammation attributable to a specific organism - Demodex.  Demodex is not susceptible to antibiotics.

To eliminate Demodex from eye lid margins there is a specific strategy involving both type of cleanser and timing of application.  These cleaners are potent.  They are applied carefully to lids.  

Timing:  Always apply these wipes and foams at bedtime.  Demodex is active at night so timing treatment is important for success.  The exception to this is the adjunct use of hypochlorous spray which should be used several times per day.  In the case of wipes... The ingredients are left on overnight and rinsed off in the morning.   In the case of foam, it is rinsed after application.  The brands and forms all work in a similar way and stop Demodex mites activity at night.

Type:  Tea Tree Oil based cleansers are the classic treatment for Demodex.

1. I-Lid N' Lash PLUS Wipes
2. Blephadex Wipes
3. Blephadex Foam

This list is organized in how I approach demodex treatment recommendations in clinic today.  This takes into account costs, effectiveness and reoccurrence.  Wipes and foam can be used concurrently.

A newer Demodex treatment that is not tea-tree based is zocular.   Available in foam and pads, I have found zocular to be highly effective and it does not have the familiar, pungent tea-tree smell.  It seems to do a great job calming inflammation faster that the classic treatments.  It is available in both Wipes (Zocuwipe) and Foam (Zocufoam)

Clinical note: Eradicating Demodex is needed to start healing but sometimes prescription steroids are used to quell the concurrent inflammation.

Tip: Demodex is extremely common, once you have it under control ... Don't stop a maintenance treatment!   It will return.    Maintenance can be 2-3 nights a week of the above mentioned cleansers plus a minimum twice daily use of hypochlorous spray (listed below) to closed lids.   Hypochlorous spray feels great and is antimicrobial.  It is well tolerated.

1. BiHOCL Hypochlorous Spray 
2. I-Lid 'N Lash Hypochlorous Spray

Demodex tratment is almost always used in conjunction with lubricant drops like :Hyabak or I-Drop PUR or HYLO or anti-evaporative products like I-Drop MGD Eye Drops or Thealoz DUO Eye Drops

Good luck and stick with treatment!

Dr Jason Morris