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Be aggressive

As much as I’ve seen, read, spoken and written about Demodex, I’m amazed that some folks still don’t recognize the signs or understand the need for aggressive treatment.

Demodex are considered by many to be a commensalism organism, but when they become clinically obvious – demonstrating dense collections of cylindrical dandruff along the base of the lashes – they have reached a pathological level and need to be addressed.

Demodex are impervious to traditional lid hygiene regimens of warm compresses and lid scrubs with baby shampoo. They require more definitive and specific therapy.

Recommended treatment

I recommend microblepharoexfoliation (BlephEx) as an initial intervention for all patients with Demodex. This treatment removes toxic, bio-laden material that accumulates along the lid margins, providing a protective habitat for the Demodex mites.

This should be performed with a gentle but effective surfactant cleanser, such as OCuSOFT Lid Scrub Plus. Beginning the next day, patients should apply Cliradex Lid Wipes to upper and lower eyelids every morning after bathing and every evening before bedtime for two weeks.

At that point, they can cut back to Cliradex just in the evening, and use the OCuSOFT foam for their morning routine. I’ll have them do this for another two weeks, and then come back for a progress assessment.

The reality is…

It’s impossible to completely rid oneself of Demodex, any more than one can completely eradicate the herpes virus. Keeping the organism in check means recognizing the signs of a flare-up and treating aggressively, or employing a maintenance regimen.

Those for whom the Cliradex wipes are well-tolerated can sometimes taper back to 2-3 times/week for ongoing use. Other options can include daily applications of lower-concentration products, such as Cliradex Light, OUST Demodex or Blephadex foam. For recalcitrant cases, I’ve found success with oral ivermectin (Stromectol).

Alan Kabat
Dr. Alan Kabat is a Professor at Southern College of Optometry and Attending Physician at The Eye Center in Memphis, Tennessee.