Myths and Facts of Demodex Blepharitis

Demodex is one of the most common causes of blepharitis, yet it still remains an often overlooked differential diagnosis. Although there is much information published on the treatment of Demodex, some dialogue still focuses on traditional treatments such as baby shampoo, lid scrubs, and ointments that are ineffective in addressing the core of the problem: the Demodex mites. Here are some myths and facts to help debunk some common beliefs surrounding Demodex Blepharitis:

Myth: Demodex Blepharitis is not very common.
Fact: A recent meta-analysis has shown that 44% of Blepharitis patients have Demodex with the prevalence increasing dramatically as people get older.1 In fact, 100% of patients aged 70 years and older are estimated to carry a colony of 1000 to 2000 mites.2

Myth: You will only find Demodex on your eyelids.
Fact: In addition to eyelids, Demodex can be found throughout the facial skin because the sebaceous glands secrete oil (the main food source for mites) more actively in the nose, cheeks, and forehead. As the Demodex population increases in these areas, it has been linked to the development of various lesions and skin diseases such as rosacea and acne.3


Myth: There are many effective treatments for killing Demodex mites.
Fact: Demodex is resistant to a wide range of antiseptic solutions4 and other traditional treatments, such as eye drops and wipes, only treat its symptoms. Cliradex® gets to the core of the problem and within days mites begin to disappear.

Myth: 4-Terpineol, the key constituent of Tea Tree Oil (TTO), and pure TTO are equally effective in eradicating Demodex.
Fact: A recent study showed that 4-Terpineol is the most important ingredient in TTO with greater effectiveness than TTO itself.5 There are also ingredients in TTO that limit its overall effectiveness and are known to cause irritation.

Myth: Using 100% TTO (melaleuca alternifolia) is safe and effective.
Fact: Pure TTO can be irritating near the eyes. Cliradex contains 4-Terpineol, which is clinically proven to kill Demodex mites better than TTO alone, and at a concentration low enough that it doesn’t irritate the eyes, and is safe for everyday use.

Myth: You have an eye related surgery scheduled, you shouldn’t not be concerned about your eyelids and lashes.
Fact: Up to 50% of refractive surgery patients have some form of ocular surface disease.6 This subsequently may result in an unstable tear film, distorted vision, and lead to patient displeasure following surgery. Patients undergoing cataract or refractive surgery can also be at great risk for infectious keratitis or even endophthalmitis.

Demodex miteMyth: Your doctor needs a microscope to diagnose Demodex.
Fact: Although initially it was helpful to have a microscope, doctors are able to diagnose Demodex without epilation7 by looking for clinical signs such as cylindrical dandruff and absence of lashes. Research shows that cylindrical dandruff is pathognomonic for Demodex.8

Myth: It’s scary to learn you have mites on your lashes.
Fact: Not really. Learning what causes your irritation, being able to manage and cure it, is much better.

To learn how Cliradex® is made, download our brochure now.

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1 Zhao Ya-E, Wu Li-P, Xu Ji-R. Association of Blepharitis with Demodex: A Meta-analysis. Ophthalmic Epidemiology. 2012; 9(2), 95-102.
2 Post CF, Juhlin E. Demodex folliculorum and blepharitis. Arch Dermatol. 1963;88:298–302
3 Jarmuda S, O’Reilly N, Zaba R, et al. Potential role of Demodex mites and bacteria in the induction of rosacea. J of Med Microbiol. 2012;, 61, 1504–1510.
4 Gao Y, Di Pascuale M, Li W, et al. In vitro and in vivo killing of ocular Demodex by tea tree oil. Br J Ophthalmol. 2005; 89:1468–1473.
5 Tighe S, Gao Y-Y, Tseng SCG. Terpinen-4-ol is the most active ingredient of tea tree oil to kill Demodex mites. Trans Vis Sci Tech. 2013; 2(7):2.
6 Luchs J, Buznego C, Trattler W. Incidence of blepharitis in patients scheduled for phacoemulsification. Presentation, ASCRS. Boston; April 2010.
7 Mastrota K. Method to Identify Demodex in the Eyelash Follicle Without Epilation. Opt & Vision Sci. 9(6), e172-174. 2013.
8 Gao YY, Di Pascuale M, Li W, et al. High prevalence of Demodex in eye lashes with cylindrical dandruff. Invest Ophthalmol Vis Sci. 2005;46:3094–3098.

Sean Tighe is a Product Development Manager and Scientist at TissueTech Inc. in Miami, FL.

  • Electra

    My grandmother just started using this product but doesn’t know if after application, her eyes need to be rinsed off with water. She says it stings for a while.

    • Christophe

      Hello, in a regular usage, Cliradex towelettes could give a small sting, nothing uncomfortable. It should feel like a fresh, menthol like sensation.

      If your grandmother are experiencing a burning sensation, there may be several causes. Here are a couple of tips to avoid it:
      1 – If you are applying Cliradex after a hot shower, skin pores are opened and you will get a stronger sting or burning sensation than normal. Try to use Cliradex in the evening, or wait 5-10mn after your shower.
      2 – Too much scrubbing! If you are using other products to clean your eyelids, like wipes or make-up remover, the eyelid skin may be more sensitive than normal. This will result in a stronger sting sensation when using Cliradex.
      3 – If Cliradex got in your eyes, it will sting. But you should be able to make the difference between your eyelids or eye balls.
      4 – Finally, it could be allergy. Very few people experience this, but it is possible to be allergic to essential oils.

      We recommend that during the application:
      1 – Closes eyes firmly without squinting too much.
      2 – Gently wipe the towelette across the lid and surrounding skin. Don’t try to push too much the towelette into the eye’s corner (caruncle).
      3 – Allow the liquid to air dry briefly (30s) before opening eyes

      If you are experiencing pain or if symptoms worsen, you should stop and refer to your physician.

      • Electra

        From my grandmother and me: Thank you so much, Christophe, for your prompt and detailed reply! It is very helpful for me to be able to convey your answer to her so soon as the poor dear is very mortified by just the thought of these awful invaders.
        Two more questions:
        1. How many times a day should she apply Cliradex?
        2. Grandma wants to know if, after she is relieved of the eyelid inflamation and itching, she needs to follow some sort of Cliradex maintenance treatment?
        Information for you: We learned about Cliradex from Grandma’s opthalmologist who gave her a box sample of 3 towelettes. But when I went to buy her more, Cliradex was not available in either CVS or Walgreens. We had to order it (2 boxes) from Amazon.
        Thank you so much, E.

        • Christophe

          1 – apply Cliradex once or twice a day (morning and evening). If she is too sensitive to it, once a day will do. Please find the best time for yourself. (for me I like it better during the day).
          I would avoid after hot shower or makeup removal.
          2 – For maintenance, with towelettes, use it 2-4 times a week or use Cliradex Light, the foam version.

  • Sina Shekarak

    I have been using Cliradex every single night for over a year now every night after my Bruder Mask. I’m only 30 years old and have been diagnosed with dry eye disease and blepharitis. Eye doctors tell me it’s the Demodex mites that probably caused my dry eyes as I never had any problems before.

    The issue is that despite using Cliradex for a year, my problems haven’t gone away. It certainly helps with flare-ups and I’m certainly better off with it than without it but it doesn’t seem to be preventing all flare ups despite daily use and no contact lens wear. Why is that? Are the mites smart enough to grow resistant to it after awhile? My question is, am I even supposed to use this daily? Or is this only for treatment of flare ups? Finally, is this best used at night before bedtime or in the morning?

    Thank you!

    • Sina, I’m sorry to hear that! To answer your questions: you should use Cliradex Towelettes when dealing with flare ups and we recommend Cliradex Light for everyday maintenance. It is most important to use Cliradex at night before going to bed because the mites reproduce at night. Usually, 3-4 weeks of consistent use will thin out their numbers. Symptoms of Demodex mites such as cylindrical dandruff around the lashes, lashes that are curling towards each other, loss of eyelashes, or severe redness and irritation. If you are experiencing Dry Eye symptoms without the aforementioned effects to your lids and lashes, we would recommend that you visit your local ophthalmologist as your Dry Eye may be unrelated to Demodex or Blepharitis. We would recommend visiting a doctor with a LipiView machine that can visualize your tear film.

      • Sina Shekarak

        Thank you for the reply.

        I have seen several ophthalmologists. I do have many of the symptoms of demodex mites including eyelashes that are curling and sometimes even ‘clashing’ with each other… like getting tangled up a bit in one another or curling toward the eye which causes irritation.

        Cliradex Light is a new product and doesn’t seem to be available in Canada, is it? I have been using the towelettes every night for that reason.

        • Thank you for being a customer. Currently, only towelettes are available. We are working to launch Light as well. In the meantime, please contact our local partner. They may be able to get you an early release.

          Bright Optical Inc.
          180 Sheppard Ave East
          Toronto, ON
          Toll-Free: (877) 870.0105
          Phone: (416) 642.0093

  • Findlay415

    Funny. After a 3 week hospital stay in 1987, I had blepharitis, no one knew what it was 25 years later my optometrist diagnosed it, gave me a package of towelettes (could have been Cliradex, this was 6 or 7 years ago) and told me to gently wash my eyelids with soap while in the shower.

    And it went away, just like that.

    I couldn’t believe it, after years of suffering with it. Mental.