Conditions We Treat
Demodex Blepharitis
Demodex blepharitis is a common — and commonly missed — cause of red, itchy, irritated eyelids. It is caused by Demodex mites, microscopic organisms that live at the base of the eyelashes. In small numbers they are normal, but an overgrowth inflames the eyelid margins and disrupts the lashes and oil glands.
The tell-tale sign: collarettes
The hallmark of Demodex blepharitis is collarettes — cylindrical cuffs of waxy debris that wrap around the base of the eyelashes, a by-product of the mites. We look for them under the microscope, often by asking you to look down so the lash bases are easy to examine. Their presence makes the diagnosis straightforward.
Common symptoms
- Itching along the eyelids — classically worse in the morning
- Redness and irritation of the eyelid margins
- Gritty, foreign-body sensation or burning
- Crusting, flaking, or debris on the lashes
- Recurrent styes or chalazia, or lashes that become brittle or misdirected
How we treat it
For years, Demodex blepharitis could only be managed indirectly. Today we have treatment aimed directly at the mites:
- Xdemvy® (lotilaner ophthalmic solution 0.25%) — an FDA-approved prescription eye drop that kills Demodex mites. It is typically used twice daily for six weeks and can clear collarettes and calm the eyelids.
- Eyelid hygiene with tea-tree-oil–based (terpinen-4-ol) cleansers or hypochlorous acid sprays to reduce mite burden and debris.
- Treating associated conditions — Demodex often coexists with meibomian gland dysfunction and evaporative dry eye, which we address together for lasting relief.
If your eyelids are persistently itchy, red, or crusty — especially first thing in the morning — a quick exam can confirm whether Demodex is the cause and start you on targeted treatment.
This page is for general education and is not medical advice. If you have symptoms or concerns, please request an appointment for an evaluation.