Lid margin before NuLids treatment
with Demodex present
Lid margin after NuLids Treatment

Millions of patients are diagnosed with demodex and blepharitis of their eyelids every year. These findings may not display any symptoms until there is damage to the patient’s eyelids and or function. The outcome can range from temporary discomfort to ocular surface disease, which is why all eye problems and diseases should be taken seriously and regular eye check-ups are essential.

When speaking to the average clinician, you will find that opinions vary as to how prevalent Demodex is in everyday practice and how invasive it is to the ocular surface. Demodex was first identified in 1841: Demodex folliculorum (0.3-0.4mm) is the larger of the two mites that affect the skin. It is more prevalent in blepharitis and is found congregated in the hair follicle. Demodex folliculorum devours epithelial cells at the follicle, and their claws create micro abrasions that cause further hyperplasia and keratinization of the epithelium. Demodex brevis (0.2-0.3mm) is found in the sebaceous gland and is more prevalent in chalazia. Demodex brevis burrow into the meibomian glands, blocking meibum secretion and initiating a granulomatous cascade, potentially causing both meibomian gland dysfunction (MGD) and chalazion. To further insult the ocular surface, Demodex transport the bacterium Streptococci, Staphylococci, and Bacillus oleronius. Additionally, their debris and waste products produce a secondary inflammatory reaction.
D. folliculorum can be diagnosed by examining the eyelid and lash margin. Here you will discover collarette dandruff is a reliable indication that Demodex is present. However, realize that especially in the cases of D. brevis, it may be present without collarette dandruff. Fully understanding this, as well as its link to rosacea and the damage that can be done, it is essential that we be aggressive in our treatment plans.

Electron microscope view of demodex mite

There are a variety of over-the-counter products available with variable success. Tea tree oil cleans the physical collarette, but also encourages exodus of the mite onto the skin. Tea tree oil is also advantageous because of its antibacterial, antifungal, and anti-inflammatory properties. Hypochlorous acid and Cliradex have long been embraced as a successful ancillary method of treatment. While we are fortunate to have an abundance of over-the-counter products available in the US, self-medicating patients can delay professional treatment and allow for significant disease progression, especially considering the ultra-fast replication cycle of Demodex. Typically, our biggest challenge is in properly assessing and treating in a timely manner.
Our industry has been in great need of a mechanical cleaning device for the lid margin. With the introduction of NuLids® we are excited to now offer an in-office treatment. NuLids is a micro-exfoliation device specifically made to clean and debride the lid-lash margin as a treatment for demodex, blepharitis, meibomian gland dysfunction, and dry eyes.

Knowing how invasive and invisible Demodex can be, a comprehensive eye examination is crucial for a proper evaluation to assess and address your ocular needs. Call us today at Total Vision Care Optometry to schedule your comprehensive ocular consultation!