Ocular Demodicosis (Demodex Infestation) Follow-up

Updated: Oct 30, 2017
  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Hampton Roy, Sr, MD  more...
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Further Outpatient Care

Terpinon-4-ol (Cliradex) may be purchased as a home care kit. In the absence of Cliradex, the following outpatient care may be followed:

  • Eyelash scrubs twice daily with a 50-50 mixture of baby shampoo and water using a cotton swab or a rough washcloth provide symptomatic relief. The assumption that patients are knowledgeable about this procedure should not be made; demonstrating the eyelash scrub technique to the patient may be necessary.

  • The patient should be prescribed two 3.5-g tubes of a viscous ointment, preferably an antibiotic ointment, mercuric oxide ointment, or 10% tea tree oil ointment. The patient should be instructed to squeeze out 1 inch of ointment and apply liberally to each lid immediately before bedtime. This is believed to inhibit the reproductive attempts of the adult Demodex. The patient is also instructed to wash out the ointment every morning with the eyelash scrubs.

  • Preventive facial hygiene with daily soap and water washes is encouraged. Long-term compliance may be a problem in patients with dry skin.

  • Dermatologic consultation may be helpful in a patient with recurrent episodes or in those with accompanying dermatologic involvement.

  • Typically, 3-4 weeks of treatment is necessary. In patients who respond to the above outlined treatment, the eyelid scrubs may be reduced to once a day and an ointment at bedtime.

  • Consequently, the treatment is reduced until the condition resolves or recurs. If recurrence of symptoms occurs during the tapering period, the patient is advised to go back to the previous treatment level and to continue at that level.

  • If the patient is unresponsive to treatment, consider noncompliance or other underlying etiologies.


Inpatient & Outpatient Medications

See the list below:

  • Terpinon-4-ol (Cliradex)

  • Ivermectin 1% cream (Soolantra)

  • 50-50 mixture of baby shampoo and water

  • Erythromycin ointment

  • Mercury oxide 1% ointment

  • Pilocarpine 4% gel

  • 10% tea tree oil ointment



The prognosis of symptomatic relief from D folliculorum is very good.

Previous clinical experience shows that total eradication is unlikely, but the mite population can be brought down to an acceptable level with little effort and easily maintained with proper hygiene.

There are promising reports of total eradication with the use of tea tree oil, terpinon-4-ol, and ivermectin 1% cream.

Recurrence of the symptoms is possible if proper hygienic measures are not used.


Patient Education

The suggested home treatment, including the eyelash scrub technique, should be demonstrated to the patient, as follows:

  • Soak the washcloth in warm water, and wring it.

  • Apply enough baby shampoo to form lather on the washcloth.

  • With the eye closed, massage the lashes on the lid margin, moving from left to right, 15 times. (Do not touch the eye itself.) Repeat on the other eye.

  • Rewet the cloth, and rinse off the shampoo.

  • Squeeze 1 inch of the ointment onto the index finger and gently rub into the lashes with the eye closed. Repeat on the other eye.

To the eye care professional, the presence of Demodex species together with signs or symptoms of lid inflammation is of greater concern than the prevalence of Demodex species in a general population.

Tea tree oil and tea tree oil shampoo may be purchased from specialty shops locally and online.