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Demodex is a tiny mite that lives on the skin of most adults, including at the base of the eyelashes. In most people it goes completely unnoticed, but in some it is linked to itching, scales and recurrent inflammation of the eyelid margins. On this page we explain what the mite is, which signs suggest it, how the eye doctor identifies it, and what may help when home care is not enough.
When to see a doctor straight away: pain in the eye (not just itching or burning); reduced vision; strong sensitivity to light; one very red eye; swelling that spreads around the eye. Signs like these are not typical of Demodex and need an examination the same day.
What is Demodex?
Demodex is a microscopic mite, invisible to the naked eye, that lives in hair follicles and in the oil glands of the skin. In the eyelids it lives in the lash follicles and in the glands along the eyelid margin, including the meibomian glands (tiny oil glands that produce the oily layer of the tears).
The mite is very common in adults, and becomes more common with age. In most cases it is harmless. The problem starts when its numbers grow: it may then irritate the eyelid margins, block the lash follicles and the gland openings, and trigger inflammation. According to professional reviews, Demodex is one of the causes of blepharitis (inflammation of the eyelid margins) that keeps coming back and does not go away.
Signs that suggest Demodex
No single sign diagnoses Demodex at home, but several signs together raise the suspicion:
- Itching along the lash line and the eyelid margins, which is often stronger in the morning.
- Redness of the eyelid margins and a feeling of irritation or burning.
- Scales and crusts at the base of the lashes, and especially "sleeves": cylindrical dandruff that wraps around the base of the lash. This is the most typical sign of Demodex.
- Lashes that fall out, break or grow in different directions.
- Styes and chalazia that come back again and again.
- Symptoms of dryness: burning, a gritty feeling and tired eyes, especially when the meibomian glands are also involved.
Demodex is more common in people with rosacea (a skin disease that causes redness of the face), and it often appears together with a problem in the meibomian glands. When itching is the main symptom and the cause is unclear, also read the page on itchy eyes.
The link between Demodex, the meibomian glands and dryness
The meibomian glands produce the thin oily layer that stops the tears from evaporating. When the mites multiply in or around the gland openings, they may block them and trigger inflammation, so the glands produce less oil, or thicker oil (MGD). The result is tears that evaporate too quickly, and symptoms of dryness: burning, a gritty feeling and blurring that improves with blinking.
So in some people who come because of "dry eye", the examination shows that they also have Demodex, and vice versa. When only lubricating drops are used, without treating the eyelid margins, the relief may be partial. Treatment that addresses both sides, the eyelids and the tears, may help more.
What the specialist checks
The diagnosis is made in an examination by an eye doctor, not from the symptoms alone:
- An examination with a slit lamp (a microscope that lets the doctor see the front of the eye under magnification), focusing on the base of the lashes and the sleeves around them.
- If needed, a few lashes are sampled and examined under a microscope to see the mites themselves. This test is done at the clinic, and it is short.
- An assessment of the eyelid margins and the meibomian glands, and tests of the tear film. See dry eye testing.
The examination also helps to find out whether other factors are contributing to the symptoms, such as allergy, dryness or rosacea, because each of them has its own treatment.
What may help
There is no one-off treatment that gets rid of Demodex. The aim is to reduce the number of mites and the inflammation, and to keep it that way over time. Treatment usually lasts weeks, and it is common for the symptoms to come back, so it is important to know this in advance.
The basis: a daily routine at home
Gentle daily cleaning of the eyelid margins and the base of the lashes, as instructed by the doctor, is the basis of any treatment. A few things help the routine succeed:
- Clean once or twice a day, gently, with your eyes closed, especially the base of the lashes.
- Remove eye make-up every evening, and replace old make-up, especially mascara.
- Change pillowcases and towels often, and do not share towels.
- Keep up the routine even after the symptoms settle, because stopping is one of the common reasons for a relapse.
The eye doctor may recommend a dedicated eyelid product or medical treatment, according to the findings of the examination. Do not apply essential oils or other products to the eyelids or near the eye yourself.
Treatments at the clinic
When the home routine is not enough, there are clinic treatments that may help some patients:
- BlephEx eyelid margin cleaning: mechanical cleaning of the eyelid margins and the base of the lashes, which removes scales, sleeves and a layer of bacteria.
- Meibomian gland expression, when the glands are blocked.
- IPL treatment (pulsed light, not a laser), when there is a problem with the meibomian glands or rosacea.
The decision about which treatments to combine, and in what order, is made after the examination and according to what you have already tried.
What not to do
- Do not rub or scratch the eyelid margins, because this increases the irritation and the inflammation.
- Do not pull out or cut the lashes to "get rid of" the mites.
- Do not apply essential oils, alcohol or products not intended for the eye area to the eyelids.
- Do not stop the routine as soon as there is an improvement, and do not start and stop products without guidance.
If the symptoms do not improve after a few weeks of a consistent routine, it is time to get examined rather than trying more and more products.
How to prepare for the examination
To make the examination effective, it is worth coming with organised information:
- When the symptoms started, and at what time of day they are stronger.
- A list of all the drops, ointments and eyelid products you have tried, and what helped.
- Whether you have rosacea, other skin problems on the face, or styes that keep coming back.
On the day of the examination it is better not to wear eye make-up, because the doctor needs to see the base of the lashes clearly. If you wear contact lenses, follow the instructions you receive when booking the appointment.
Why Demodex comes back
The mite is part of the skin of most adults, so even after successful treatment it may return and multiply. Problems linked to it, such as rosacea or blocked meibomian glands, also tend to be chronic. That is why it is worth continuing the eyelid-cleaning routine even when the symptoms settle, and coming back for an examination if the itching, scales or styes return. You will find broader information on chronic eyelid inflammation on the blepharitis page.
Want a basic explanation first?For basic information on eyelid hygiene: the guide on the Mitzmutz site
Frequently asked questions
Is Demodex contagious?
The mite can pass between people through close contact, but it is very common in adults even without any symptoms. So finding it in one person does not necessarily mean that family members need treatment. It is best not to share towels, pillows and eye make-up, and anyone with similar symptoms can consult an eye doctor.
Does Demodex go away on its own?
Usually not completely. The mite is part of the skin of most adults, and the aim of treatment is to reduce its numbers and the inflammation, not to get rid of it for good. Without a treatment routine, the symptoms tend to come back.
How long does treatment take?
Treatment usually lasts weeks, not days, because the mites that hatch from eggs over time also need to be treated. Even after an improvement, it is common for the symptoms to come back, which is why you continue an eyelid-cleaning routine.
Can I put tea tree oil on my eyelids?
Do not apply essential oils, including tea tree oil, to the eyelids or near the eye yourself. They may irritate the eye a great deal. If a dedicated eyelid product is needed, the eye doctor will recommend one and show you how to use it.
Home care not enough? We can look into it.
At the dry eye clinic in Haifa we find out what is causing the dryness and build a personal treatment plan.
Sources
- Liu J, Sheha H, Tseng SC. Pathogenic role of Demodex mites in blepharitis. Curr Opin Allergy Clin Immunol. 2010;10(5):505-510.
- Amescua G, Akpek EK, Farid M, et al. Blepharitis Preferred Practice Pattern®. Ophthalmology. 2019;126(1):P56-P93.
- Geerling G, Tauber J, Baudouin C, et al. The International Workshop on Meibomian Gland Dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2011;52(4):2050-2064.
- Vieira AC, Mannis MJ. Ocular rosacea: common and commonly missed. J Am Acad Dermatol. 2013;69(6 Suppl 1):S36-S41.
The information on this site is general only. It is not medical advice and does not replace an examination by an eye doctor.