Ocular Demodicosis (Demodex Infestation) Medication

Updated: Feb 02, 2023
  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication Summary

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. A tea tree oil product (Cliradex) can be used. [15] Terpinen-4-ol is the most active component of tea tree oil. 

The antiparasitic ophthalmic solution lotilaner (Xdemvy) was approved by the FDA for treatment of Demodex blepharitis in July 2023. [31, 32]   



Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of this clinical setting.

Erythromycin ophthalmic (Ilotycin)

Belongs to the macrolide group of antibiotics. Basic and readily forms a salt when combined with an acid. Inhibits protein synthesis without affecting nucleic acid synthesis.

Used for the treatment of ocular infections involving the lids, conjunctiva, and/or cornea caused by organisms susceptible to it.


Cholinergics/miotic agents

Class Summary

Dosage and frequency of administration must be individualized. Patients with darkly pigmented irides may require higher strengths of pilocarpine.

Pilocarpine ophthalmic (Pilopine HS 4%, Isopto Carpine)

Produces miosis through contraction of iris sphincter muscle, which pulls iris root away from trabecular meshwork in angle-closure glaucoma and allows aqueous humor to exit eye, thereby lowering IOP. Also causes ciliary muscle contraction, resulting in accommodation and increased tension on and opening of trabecular meshwork spaces, facilitating aqueous humor outflow and lowering IOP in open-angle glaucoma.



Class Summary

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.

Ivermectin topical (Sklice, Soolantra)

Pediculicide derived from fermentation of a soil-dwelling actinomycete, Streptomyces avermitilis.

Causes parasite death by selective, high-affinity binding to glutamate-gated chloride channels located in invertebrate nerve and muscle cells; this results in increased cell membrane permeability to chloride ions with hyperpolarization of the nerve or muscle cells, and ultimately parasite paralysis and death.

Ivermectin cream (Soolantra) has both anti-inflammatory and antiparasitic activity.

Lotilaner ophthalmic (Xdemvy)

Gamma-aminobutyric acid (GABA)-gated chloride channel inhibitor selective for mites. Inhibition of these GABA chloride channels causes a paralytic action in the target organism, leading to its death. It is indicated for adults for treatment of Demodex blepharitis.