New Approaches for Fighting Demodex Mites

By Keynote ContributorBy Dr. Kathryn Najafi-Tagol, MDFounder and Medical Director of the Eye Institute of Marin

By Dr. Kathryn Najafi-Tagol, MD, Founder and Medical Director of the Eye Institute of Marin

Demodex mites are one of the most challenging problems that ophthalmologists and optometrists face in the routine care of their patients.

© Kalcutta / Shutterstock.com

These mites are microscopic parasites that live on eyelids and other parts of the face. One of the two species, Demodex folliculorum, buries itself face down near the roots of eyelashes. It uses a seven-clawed organ (a “palpus”) to grab hold of cells. Then it feasts on the cells that line the follicle, sucking out their innards with a retractable needle in the middle of a round mouth.

The waste material the mites produce builds up as debris on the eyelids and causes inflammation.

In addition, the D. folliculorum typically carries Staphylococcus and Bacillus oleronius bacteria.

© Kalcutta / Shutterstock.com

The combination of mites and bacteria causes blepharitis, a condition suffered by more than 20 million Americans, where the eyes become red, irritated and painful, and crusty debris builds up on the eyes.

Meanwhile, the other species, Demodex brevis, burrows into meibomian gland to feed, often plugging up this crucial gland. The gland produces an oily substance that’s necessary to keep tears from evaporating. As a result, the D. brevis mites are associated with meibomian gland disease, also known as dry eye.

These parasites are common. One study found them in 25% of 20-year-olds, 30% of 50-year-olds and 100% in patients older than 90 years old.

My own patients are usually horrified when I tell them that there are tiny parasites, which are relatives of ticks, spiders, and scorpions, feasting on cells around their eyes.

So how can we fight these parasites? There are several approaches, which can be combined to attack the mites on multiple fronts:

Tea Tree Oil

At high concentrations, tea tree oil is a potent killer of Demodex mites. The problem is that solutions of 100% tea oil, or other high concentrations, are very irritating to the eye. So one approach is to thoroughly wipe the eyelashes and eyebrows with a diluted solution of tea tree oil, from 5% to 50%. We can also first use an anesthetic eyedrop to lessen the irritation from the tea tree oil.

In one study, a daily lid wipe with a 5% solution of tea tree oil reduced both the numbers of mites and the perceived itchiness of the eyes.3 Until recently, tea tree oil was the main method of keeping the mites in check.

Antibiotics & Steroids

An antibiotic steroid ointment can help prevent the mites from moving. It may even suffocate them. The combination of antibiotics and steroids is also a standard treatment for blepharitis. The steroid reduces inflammation, which is caused by the mites, the bacteria, and treatments like tea tree oil wipes. In addition, the antibiotic helps control the bacteria.

The problem with this approach is that steroids can worsen glaucoma, while chronic use of antibiotics can lead to the development of bacteria that are resistant to the antibiotics.

Hypochlorous Acid

Hypochlorous acid (HOCl) is a naturally occurring substance produced by white blood cells as a first defense against microbial invaders. Its antimicrobial properties were recognized more than 100 years ago, when solutions containing HOCl were used to combat infections in the wounds of soldiers injured in WWI.

Only recently, however, has it been possible to manufacture a stable, pure version of HOCl. HOCl has potent antimicrobial properties. Laboratory studies show that it effectively kills the nymph form of the Demodex mites, as well as the Bacillus oleronius and Staphylococcus aureus bacteria that live on eyelids and that are found inside the Demodex gut. In addition, HOCl also neutralizes the inflammatory toxins released by both mites and bacteria.

Moreover, unlike tea tree oil, HOCl is completely non-toxic and non-irritating.

© Nyrelle Hawkins / Shutterstock.com

Home Hygiene

Treating eyes and eyelids can bring quick relief to patients, many of whom have suffered from Demodex mites, blepharitis, or dry eye for years.

But there are also steps patients can take at home to further reduce the problem. I recommend washing sheets and pillowcases in hot water and drying with the hottest possible dryer setting to kill the mites that might otherwise jump from bedding to faces. In some cases, it might even help to get new pillows. Patients might also consider not using makeup for a week, and discarding their old makeup.

Many doctors worry that patients won’t comply with the treatments they recommend. But I find that once I describe to patients how parasites are burrowing into their cells and feasting on their bodies, especially if I show them pictures of the microscopic creatures, I get their attention and their complete cooperation. In addition, if the treatment is irritating like tea tree oil products, the patients are less likely to be compliant; however, if the therapy feels comfortable and makes the eyelids feel more refreshed, the patients are more likely to adhere to the regime.

And the good news is that, after years of fighting mites and treating chronic blepharitis, new approaches are making it more likely that we can finally effectively control these conditions.

Sources

Further Reading


Disclaimer: This article has not been subjected to peer review and is presented as the personal views of a qualified expert in the subject in accordance with the general terms and condition of use of the News-Medical.Net website.

Last Updated: Jun 25, 2019

Comments

  1. Linda Haghgoo Linda Haghgoo United States says:

    Wash your face as soon as possible when you wake up because they retreat into us when light hits them. I use Kirk's coconut soap

  2. Helen Turner Helen Turner United States says:

    Anyone have an idea what to do with our cloth stuffed recliners we use to take naps in the afternoon? The article suggest throwing pillows away.

  3. HRFNEMDW 3JNK4REDMF HRFNEMDW 3JNK4REDMF United States says:

    THIS IS A LIE!!! ALMOST EVERY PERSON ON EARTH HAS THESE AND THEYRE JUST FUNKY LITTLE MITES!! THEY DONT CARRY BACTERIA, AND THE ONLY HARM THEY CAN DO IS OVERPOPULATION IN LOW IMMUNE SYSTEMS WHICH CAUSES A RASH >Frown DO NOT SLANDER MY FRIENDS!! THE MITES ARE SO CUTE AND PGOGERS

  4. Ingrid Tarien Ingrid Tarien United States says:

    Good article. A few questions and comments for clarification:
    1. The mites have no anus and they eventually deteriorate or rupture after their 2 week lifespan (releasing whatever has been building up inside them). (There is reference to “the waste material that mites produce” but they don’t actually produce waste in the sense that they can’t poop, not having an anus. Maybe the reference is to what they have stored up inside them that gets released when they break down/rupture after death).
    2. I’ve read males outnumber females by 4-5x. They come out only at night (thus washing in daytime would have limited effect?). Nothing really reaches them inside the follicle and inside the pores as far as I understand. Can you elaborate on this detail please?
    3. They mate at night near the surface of the skin and the female heads back down to eventually lay about 20 eggs. An army of 20 from any one mite missed is a big threat. Would be great to keep them from mating.
    4. It seems that to be really effective, washing and treating should take place at night (away from light). I don’t know if such simple organisms have any rhythms that tell them what time is appropriate other than sensing bright light (if you cover an eye with a tightly fitting dark cup at noon, will they think it is night?)
    5. Does mineral (or other) oil clog their respiration and kill them? Little is written on Demodex from a phylogenetic perspective. I assume they respire somewhat like termites do, from openings in the sides of their body. If so, they should be capable of being suffocated by such - but reaching them/finding access to them doesn’t seem at all easy (they’re not on top of the skin; when we wash, we wash right over where they reside in the pores).
    6. Don’t know what they are made of (chitin exoskeleton?). With regard to using hot water and hot drying cycle, don’t they expire under water when detergent/soap is added (not pure water, as fleas also walk right off the water - the soap would break the surface tension of water and take them down). I don’t see how they could survive a wash cycle. Seems all air pockets would be pretty much gone in fabrics.
    7. With “jumping” from bedding to face - aren’t these extremely slow crawling .3 mm creatures who only move a very short distance in an hour. They don’t have the ability to “jump,” right? The word may be have been used figuratively.
    8. If they only live about 2 weeks, I imagine they don’t survive in the environment (and certainly can’t mate) - so the environment doesn’t seem like much of a threat unless you’re burying your face in something or using hands in a sloppy way (we don’t want them anywhere, but they’re still ubiquitous on humans). And humans only - they are not transmitted to/from pets (dogs and cats have their own species). I don’t know if they can survive harmlessly on another host long enough to live out their short life, but they would not be able to mate and make more (just like if they were on carpet)

    • Helen Cochems Helen Cochems United States says:

      Hello.  I would sure like to learn more about DIY treatments for scalp mites.  Your post provided useful clarification in many areas.  I especially like your use of the term phylogenetic perspective, which is new to me, and will help me in my search.  Thank you very much.

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