Blepharitis Not Improving? Eyelash Mites Be To Blame

We've all been there.
 
Waking up to find yourself itching your eyes. While in the bathroom, the mirror confirms what you dreaded.
 
 
Just when you thought you were getting on top of things, a busy week has seen you neglect your eyelid hygiene. You think to yourself "months of diligent scrubbing, only to return to square one after a couple busy weeks. What's the point of it all?"
  
Blepharitis is a chronic condition, with many causes. But there's one culprit that's stubborn and typical treatments don't work.
 
Eyelash mites (Demodex) might be to blame. 
 
These mites can wreck havoc for years because:
  • Diagnosis is difficult
  • Treatment is different to the usual eyelid hygiene practices
 

What Are Eyelash Mites?

Demodex are mites live in the base of eyelashes. They can be passed on through direct contact or eggs found in dust. While they only live 3 weeks, one mite can lay 20 eggs.
 
Demodex mites feed on dead skin cells and oils around the eyelash. This provides larvae a constant source of nutrients, as soon as they hatch. Dead mites and their waste can plug up the glands. This interferes with producing healthy tears - the eye's natural defence mechanism.
 
The cycle of producing mites and worsening eyelid irritation continues! It's no wonder, one of the main symptoms of Demodex is an itchy eyelid.
 
These mites affect all age groups, and are more common than you think.
Interestingly, women who wear makeup are less likely to have Demodex on their skin.
 

How Are They Diagnosed?

It takes an eye doctor to perform an extensive examination to diagnose a Demodex infestation.
 
According to Dr Tseng:
 
"One of the trademark signs of Demodex mites is cylindrical-shaped dandruff at the root of the lashes".
This is different to 'flaky' dandruff that can be anywhere along the lashes in the case of a Staph infection.
eyelash mites blepharitis not improving

Cylindrical dandruff at the root of the lashes is typical of a Demodex infestation - Source Review of Optometry

 
Pulling out an eyelash and examining under a microscope can confirm suspicions. If an eyelash has dandruff and is discoloured or brittle, it will be used for sampling. One study found eyelashes with dandruff were 10x more likely to contain Demodex mites.
 
However, just because there are no mites observed under the microscope does not mean Demodex isn't around. Dr Safran believes Demodex are commonly found on the skin around the eye. Some clinicians are able to rotate and pinch the eyelashes to see the tails of the mites emerge under slit-lamp.
 
A high resolution, magnified image of the lid margins can be achieved using a Blephcam. This can help observe Demodex mites in real-time. 
 
So if you're not sure - see the experts!
 

What's The Treatment?

These mites don't respond to the typical scrubs, warm compress and antimicrobial solutions.
 
Eyelash mites are resistant to a wide range of antiseptics and even 75% alcohol.
 
Because the mites carry bacteria and leave waste, antibiotics and scrubs may work initially. This can be misleading, since it may appear your symptoms are improving. But without the right treatment, you won't be addressing the cause - killing the mites.
 
So how are the mites killed?
 

Tea Tree Oil

Tea tree oil works by dislodging mites from the base of the lash and killing them. But this doesn't mean you should rush to the nearest pharmacist and start splashing tea tree oil over your eyes. Tea tree oil alone is too toxic to be applied to the delicate skin around your eyelids
 
Two solutions appropriate for eyes containing tea tree oil are Cliradex  and Blephadex. Twice a day scrubs using these solutions for 6 weeks should see the Demodex mites eradicated. When scrubbing, try not to immediately rinse off the solution. Keep it on the eyes for a minute if possible to let it take effect on the mites.
eyelash mites blepharitis not improving

Blephadex and Cliradex both contain components of Tea Tree Oil that won't hurt your eyes

 
Some studies recommend diluting 50% of tea tree oil, but I find these home remedies too irritating and not as effective.
 
Since you might have eggs that have not hatched, it's recommended to continue treatment for a few months, to prevent Demodex coming back.
 

Whole Body Hygiene

Treating the eyes alone won't be enough to kill Demodex. They also live on your hair, face, ears and reside in linen.
 
Hair must be treated with tea tree shampoo. According to Dr Safran:
 
"You are not going to get rid of Demodex if you don't shampoo your hair [with tea tree oil]".
 
Invest in a good tea tree shampoo and use it daily on your hair, face and your closed eyes while in the shower.
blepharitis not improving

Cleaning linen in hot water is crucial for killing Demodex

 
It's essential to wash all linen in hot water, replace pillowcases or rest your head on a clean fabric while you sleep. When washing, adding in some pure tea tree oil (~20 drops) to kill any stubborn mites clinging to your linen. Aim to wash your bedding at least once a week.
 
Make sure to sterilise any makeup applicators with tea tree oil, since alcohol wipes don't work.
 

Sometimes You Need A Little Extra Help

Occasionally, the above measures aren't enough to stem the mites.
 
Dr Schachter treats severe cases of Demodex with microblepharoexfoliation. This provides a thorough clean to remove all waste and dead mites. Having the eyelid margins exfoliated may help in your fight against Demodex . BondiEyes also cleans eyelashes to prevent mites from coming back.
 
 

Conclusion

If you're not responding to the usual Blepharitis treatments - it might be worth visiting your eye doctor to ask about a Demodex infestation. They are more common than you might think.
 
Demodex requires specifically-made tea tree oil scrubs, shampoo and regular linen washing. It's hard work, but after a few months you may have found the 'cure' to your long-standing symptoms.

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