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How to Eradicate Demodex Mites


Demodex blepharitis is a common yet often overlooked condition that can significantly impact ocular health. 
Demodex mites are microscopic parasites that live in the hair follicles and sebaceous glands of humans. There are two species primarily associated with ocular conditions: Demodex folliculorum and Demodex brevis. These mites can infest the eyelids, including lash follicles and sebaceous glands, leading to a condition known as Demodex blepharitis.1


Demodex blepharitis is characterized by inflammation of the eyelids, which can cause symptoms such as itching, redness, and crusting at the base of the eyelashes called collarettes. If left untreated, it can lead to more severe complications, including chronic eyelid inflammation, conjunctivitis, and keratitis. Moreover, Demodex infestation is a significant contributor to dry eye disease. The mites contributes to meibomian gland dysfunction and disrupting the tear film, thus exacerbating dry eye symptoms.
 Addressing the underlying mite infestation can alleviate symptoms and improve overall ocular health.

Below are key treatment options available for Demodex Blepharitis:2

ZEST is a highly effective in-office procedure designed to target blepharitis and Demodex. The treatment involves applying okra-based gel to the eyelid margin and lashes with manual debridement and cleansing to remove oil, debris, and bacteria. The okra-based gel is effective in killing Demodex mites for subsequent reduction in inflammation and irritation associated with Demodex blepharitis

For More Information on ZEST at North Toronto Eye Care

IPL therapy is an innovative treatment for Demodex blepharitis, leveraging light energy to target the underlying causes of inflammation and mite infestation. IPL uses calibrated wavelengths of light that are absorbed by the pigmented chromophores in the mites’ exoskeletons, leading to their elimination along with the bacteria they carry. This reduction in bacterial load on the eyelids helps alleviate chronic inflammation and improving meibomian gland function.

For More Information on IPL at North Toronto Eye Care

Home Adjunctive Therapies primarily focus on alleviating symptoms associated with Dry Eye Disease that occur from Demodex blepharitis.

  • Eyelid scrubs or foams with Tea Tree Oil:
    Tea tree oil-based cleansers are widely used due to their antimicrobial properties that reduce Demodex and bacterial load. However, its effectiveness depends on concentration and compliance, and it may cause irritation or allergic reactions in some patients
  • Hypochlorous Acid Cleansers
    Hypochlorous acid also has antimicrobial and anti-inflammatory properties that reduce Demodex and bacterial load. Regular use of hypochlorous acid cleansers helps maintain better eyelid hygiene.
  • Hot Compresses and Omega 3 supplements help reduce inflammation and meibum flow associated with meibomian gland dysfunction that is often associated with Demodex blepharitis.

Ivermectin is an anti-parasitic agent that works to target Demodex mites. It is however considered off-label use as Ivermectin is not officially approved for Demodex blepharitis.



XDEMVY® (lotilaner ophthalmic solution 0.25%) is a groundbreaking, the first FDA-approved treatment for Demodex blepharitis, offering significant advantages over traditional therapies as it addresses the root cause rather than just symptoms.3
 XDEMVY offers a new option for patients suffering from Demodex blepharitis. This new drug works by selectively inhibiting GABA neurotransmitter channels of Demodex mites, leading to their paralysis and death. This mechanism is highly specific and effective in eradicating mites.

Clinical trials (SATURN-1 and SATURN-2) demonstrated that XDEMVY significantly reduces collarettes, mite presence, and redness within six weeks, with many patients experiencing relief in as little as two weeks.4
While XDEMVY is widely available in the U.S., it is not yet available in Canada as it has not yet been listed in Health Canada’s Drug Product Database.


Treatment for Demodex blepharitis should be tailored to the individual based on severity and symptoms. Combining eyelid hygiene, prescription medications like XDEMVY®, and advanced in-office procedures such as ZEST and IPL ensures optimal outcomes.5 Regular follow-ups with an eye care professional are essential for monitoring progress and adjusting treatments as needed.

Please ask our doctors at North Toronto Eye Care on the Canadian availability for XDEMVY® if you have blepharitis!

References:

  1. Clinical diagnosis and management of Demodex blepharitis – Nature https://www.nature.com/articles/s41433-023-02500-4
  2. Advances in the Treatment of Demodex Blepharitis https://www.ajmc.com/view/advances-in-the-treatment-of-demodex-blepharitis-strategies-for-improving-patient-outcomes
  3. Tarsus announces Xdemvy availability at pharmacies nationwide https://www.optometrytimes.com/view/tarsus-announces-xdemvy-availability-at-pharmacies-nationwide
  4. Effectively Treating Demodex Blepharitis https://crstoday.com/articles/effectively-treating-demodex-blepharitis/effectively-treating-demodex-blepharitis-2
  5. Trends in the Management of Demodex Blepharitis Highlight the … https://www.jmcp.org/pb-assets/Outserts/23164%20-%20Tarsus_JMCP_Paper_Spotlight.FINAL-1696953438710.pdf