Demodicosis Treatment & Management

  • Author: Manolette R Roque, MD, MBA; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jun 29, 2011
 

Medical Care

The treatment regimen is divided into in-office care and at-home care.

  • In the office, D folliculorum can be lured to the follicle surface with the use of volatile fluids, such as ether (not allowed in the United States), brushed vigorously across the external lid margin, following 0.5% proparacaine instillation. Five minutes later, a solution of 70% alcohol is applied in a similar manner. This regimen is reported to successfully reduce both the symptoms and the observed number of mites by the end of 3 weekly visits. Ether and alcohol should be used with caution, and corneal contact should be prevented.
  • A combination of this in-office treatment with a home regimen is suggested. The home regimen includes scrubbing the eyelids twice daily with baby shampoo diluted with water to yield a 50% dilution and applying an antibiotic ointment at night until resolution of symptoms.
  • Various treatments have been used to control Demodex mites. Most treatments involve spreading an ointment at the base of the eyelashes at night to trap mites as they emerge from their burrow and/or move from one follicle to another.
    • Mercury oxide 1% ointment is frequently used.
    • Pilocarpine gel reduced the number of mites and alleviated the symptom of itching in 11 patients in a nursing home. Celerio et al hypothesized that pilocarpine was directly toxic to the mites because its muscarinic action impedes respiration and motility.[6]
  • The latest popular treatment regimen includes the use of 50% tea tree oil with Macadamia nut oil, applied with cotton tip applicators, after one drop of tetracaine.[7, 8, 9]
    • Aggressively debride the lashes and the lash roots first with scrubs. Try to get the oil into the lash roots and along the lashes to kill any eggs. Treat the eyebrows as well. Three applications, 10 minutes apart, per visit are recommended; treatment is completed with compounded 20% tea tree ointment. Repeat for 3 visits, each one week apart.
    • Home regimen includes the following:
      • Use tea tree shampoo on hair and eye lashes every day.
      • Use tea tree soap or face wash every day.
      • Buy new makeup and discard old makeup; do not use makeup for 1 week.
      • Clean sheets and buy new pillows.
      • Check spouse; if both have this problem, both need to be treated.
      • Check pets.
      • For the first few weeks, use the ointment at night after tea tree shampoo scrubs. If inflammation is present, combination steroid-antibiotic ointments may be applied for one week. This is then replaced with a pure antibiotic ointment or with compounded 10% tea tree ointment.
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Consultations

Weekly follow-up visits for 4 weeks may be necessary in severe cases to monitor the effects of in-office and at-home treatment regimen.

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Contributor Information and Disclosures
Author

Manolette R Roque, MD, MBA  General Manager, Full Partner, Ophthalmic Consultants Philippines Co.; President and CEO, Chief Refractive Surgeon, EYE REPUBLIC Ophthalmology Clinic; Section Chief, Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center; Section Chief, Ocular Immunology and Uveitis, International Eye Institute, St Luke's Medical Center Global City; Senior Eye Surgeon, The LASIK Surgery Clinic; Director, AMC Eye Center, Alabang Medical Center; President, Philippine Ocular Inflammation Society

Manolette R Roque, MD, MBA is a member of the following medical societies: American Academy of Ophthalmic Executives, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Administrators, American Uveitis Society, International Ocular Inflammation Society, Philippine Medical Association, Philippine Ocular Inflammation Society, and Philippine Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Barbara L Roque, MD  Full Partner, Ophthalmic Consultants Philippines Co; Service Chief, Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, Asian Hospital and Medical Center; Active Staff, International Eye Institute, St Luke's Medical Center Global City; Visiting Ophthalmologist, AMC Eye Center, Alabang Medical Center

Barbara L Roque, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Cataract and Refractive Surgery, Philippine Academy of Ophthalmology, Philippine Society of Cataract and Refractive Surgery, and Philippine Society of Pediatric Ophthalmolo

Disclosure: Nothing to disclose.

C Stephen Foster, MD, FACS, FACR, FAAO  Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution

C Stephen Foster, MD, FACS, FACR, FAAO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgments

The author was a fellow and affiliated with the Ocular Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, while performing this work.

References

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Illustration of Demodex folliculorum. Reprinted from BIODIDAC, Arthropoda Chelicerata Demodex, submitted by Livingstone, with permission from Antoine Morin, Biodidac, University of Ottawa.
Eyelid section shows Demodex folliculorum (M) in the hair follicle. Note mite mouthparts (arrow) embedded in epithelium and straplike layers of keratin (hematoxylin and eosin, X400). Reprinted from Am J Ophthal Vol. 91, English FP, Nutting WB, Demodicosis of Ophthalmic Concern, 362-372, 1981, with permission from Elsevier Science.
Section of sebaceous gland of an eyelash shows Demodex brevis (M). Note gland cell (C) destruction (McManus, X375). Reprinted from Am J Ophthal Vol. 91, English FP, Nutting WB, Demodicosis of Ophthalmic Concern, 362-372, 1981, with permission from Elsevier Science.
Cross-section through small hair follicle of the eyelid. Note distension, hyperplasia, and moderate epithelial keratinization caused by the activities of Demodex folliculorum (arrow) (hematoxylin and eosin, X375). Reprinted from Am J Ophthal Vol. 91, English FP, Nutting WB, Demodicosis of Ophthalmic Concern, 362-372, 1981, with permission from Elsevier Science.
Section of eyelid shows eyelash (L), cuffing (C), and small segment of Demodex folliculorum (M). Note layering of cuff (Masson, X275). Reprinted from Am J Ophthal Vol. 91, English FP, Nutting WB, Demodicosis of Ophthalmic Concern, 362-372, 1981, with permission from Elsevier Science.
Demodex folliculorum.
Demodex along the shaft of the cilia.
Demodex along the shaft of the cilia (higher magnification).
Backsides of numerous pubic crabs with infestation of the lashes and secondary blepharitis. Reprinted with permission from H.D. Riley, OD, Indiana University School of Optometry.
Phthiriasis (Phthirus pubis) pubic crab lash infestation and secondary blepharitis. Reprinted with permission from H.D. Riley, OD, Indiana University School of Optometry.
Phthiriasis (pubic lice). Reprinted with permission from H.D. Riley, OD, Indiana University School of Optometry.
 
 
 
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