Therapies such as tee tree oil and other OTC agents are evaluated in the management of Demodex blepharitis.
Christopher Starr, MD, FACS: Prior to recent times, we did use and sort of refer to tea tree oil products, over-the-counter products for hopefully managing Demodex to some degree. But we do know that there was a Cochrane Review that showed very uncertain, if any, benefits of using those products in the context of Demodex blepharitis. But I can tell you, as someone who's prescribed these things many, many times, that the patients often come back and say, "Oh, that tea tree oil burned, it stung. I used that a couple of times and I had to stop. I just couldn't use it any longer because it was just so irritating." It's not that I don't think I've seen any cases of Demodex that were actually cured by tea tree oil, but it can help. It's certainly an adjunctive thing that can help somewhat in some patients at moderating some of the symptoms, but I don't think I've ever seen it fully eradicate mites and cure Demodex.
Other things that have been shown to be somewhat effective, but again, not fully effective, are microbuffer exfoliation, which is a procedure that we do in the office that can certainly help to debulk the collarets and some of the lipid-margined biofilms that some of these little mites will feed on. It's again, very gross, but that would be the real life, and that can certainly help. Sometimes that, in combination with tea tree oil and other off-the-shelf [or] over-the-counter treatments that we usually recommend, can reduce collarets and maybe reduce the Demodex load to some degree. But again, not reliably a cure for Demodex. Hypochlorite acid wipes, I often tell patients to goop up their eyelids with ointment, over-the-counter ointment, to see if that can impede the mites from coming out of the eyelash follicles at night and squirming along the eyelid margin and laying eggs and all of that.
We've been scrambling for lots of little things and we sort of recommend all of these things to patients, historically, who have Demodex, with varying degrees of success. Ivermectin and metronidazole have been tried, but [in] small studies and certainly not FDA approved for this. All these off-label things that we've tried over the years, again, with minimal and very unreliable success.
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