Vision Care Services

Blepharitis & Demodex

Red, itchy, crusty eyelids, treated at the source.

Blepharitis is inflammation of the eyelid margins, where the lashes grow. It causes red, itchy, crusty or burning eyelids, flaking at the base of the lashes, and eyes that feel gritty or tired. It’s one of the most common reasons for dry eye and recurring styes.

A frequent cause is Demodex, tiny mites that live in the eyelash follicles. We diagnose the cause under the slit lamp and treat it, including with Xdemvy, the prescription eye drop approved for Demodex blepharitis.

Call the same day if eyelid swelling is spreading, the eyelid is hot and red, or your vision changes.

Xdemvy (lotilaner 0.25%)A prescription drop used twice a day for six weeks that targets Demodex mites.

In-office lid careCleaning the lid margins and treating blocked oil glands, including TearCare.

Prescription medicationAntibiotic and steroid drops or ointments, and oral doxycycline or azithromycin when needed.

Signs and symptoms

Red, swollen or itchy eyelid margins
Crusting, flakes or “dandruff” at the base of the lashes, especially in the morning
Collarettes: cuff-like crusts wrapped around the base of the lashes, a telltale sign of Demodex
Burning, gritty or watery eyes
Lashes falling out or growing in the wrong direction
Repeat styes or chalazia

Types of blepharitis

Anterior blepharitis affects the front edge of the eyelid where the lashes attach, and is often caused by bacteria or Demodex. Posterior blepharitis involves the oil glands along the inner edge of the lid, called meibomian gland dysfunction (MGD), and is closely linked to dry eye and rosacea. Many people have both.

How we diagnose it

We examine your eyelids, lashes and oil glands under high magnification at the slit lamp and look for collarettes, which signal Demodex. We record photos and video with our SLEYECAM camera so you can see what we see and so we can compare at your follow-up visit.

Treatment

Xdemvy for Demodex blepharitis, used twice daily for six weeks. In the Saturn-2 clinical trial, many more patients using Xdemvy had their collarettes cleared than patients using a placebo drop.
Eyelid hygiene: warm compresses and lid cleansers or wipes, as directed
TearCare and in-office expression for blocked oil glands
Prescription antibiotic or steroid drops and ointments for flare-ups
Oral doxycycline or azithromycin for posterior blepharitis and ocular rosacea
Treating related dry eye, allergies and skin conditions

Living with blepharitis

Blepharitis is often long-term, but it can be well controlled. Keep up with lid hygiene, replace eye makeup regularly, wash pillowcases often, and come back if symptoms flare. Treating Demodex and the oil glands usually means fewer flare-ups and fewer styes.

Common questions

What is blepharitis?

Blepharitis is inflammation of the eyelid margins, where the lashes grow. It causes red, itchy, crusty or burning eyelids and is a common cause of dry eye and styes.

What are Demodex mites?

Demodex are tiny mites that live in hair follicles, including the eyelashes. When there are too many, they can cause Demodex blepharitis, with crusty collarettes at the base of the lashes, itching and redness.

What is Xdemvy?

Xdemvy (lotilaner ophthalmic solution 0.25%) is a prescription eye drop approved by the FDA for Demodex blepharitis. It is used in each eye twice a day for six weeks. Our optometrists prescribe it.

Is blepharitis contagious?

No. Blepharitis is not contagious, although Demodex mites are very common and can pass between people through close contact.

Can blepharitis be cured?

Blepharitis is often a long-term condition, but treatment can control it very well. Treating Demodex and the eyelid oil glands often leads to long stretches without symptoms.

Does tea tree oil help Demodex?

Tea tree oil products have been used for Demodex, but they can irritate the eyes. Ask us before using them; Xdemvy is a prescription option designed for Demodex blepharitis.