ocular demodex, tea tree oil as a treatment

This recently published paper suggests that a variety of ocular symptoms might be caused by demodex infestation. Six patients all having demodex present, and suffering with recalcitrant symptoms (including 4 diagnosed with rosacea) were given tea tree oil for a weekly eyelid scrub and tea tree shampoo for a daily scrub. All patients showed a large decrease in demodex counts and relief from their symptoms.

Other recently published studies are showing that tea tree oil kills demodex. See ;

• Clinical treatment of ocular demodecosis by lid scrub with tea tree oil., Cornea. 2007 Feb;26(2):136-43. Conclusions: Demodex potentially causes ocular surface inflammation, meibomian gland dysfunction, and lash abnormalities. Lid scrub with TTO can effectively eradicate ocular Demodex and result in subjective and objective improvements. This preliminary positive result warrants future prospective investigation of Demodex pathogenicity.
• In vitro and in vivo killing of ocular Demodex by tea tree oil. [full text], Br J Ophthalmol. 2005 Nov;89(11):1468-73 Conclusions: Demodex is resistant to a wide range of antiseptic solutions. Weekly lid scrub with 50% TTO and daily lid scrub with tea tree shampoo is effective in eradicating ocular Demodex.

I have always pushed the line that demodex mites have thus far only been proven to be innocent bystanders in rosacea symptoms. In order to prove that the mites are responsible for some ocular symptoms we now need double blind studies to show 2 things - firstly that killing demodex does lead to a reduction in ocular rosacea symptoms and secondly some studies that show how tea tree oil works. We also now need larger studies that confirm that tea tree oil is a safe therapy for ocular symptoms.

Corneal Manifestations of Ocular Demodex Infestation, Kheirkhah A, Casas V, Li W, Raju VK, Tseng SC., Ocular Surface Center, Miami, Florida. Am J Ophthalmol. 2007 Mar 19

PURPOSE: To report the corneal manifestations in eyes with Demodex infestation of the eyelids.

DESIGN: Noncomparative, interventional case series.

METHODS: This retrospective review included six patients with Demodex blepharitis who also exhibited corneal abnormalities, which led to suspicion of limbal stem cell deficiency in three cases. All patients received weekly lid scrubs with 50% tea tree oil and a daily lid scrubs with tea tree shampoo for a minimum of six weeks. Improvement of symptoms and corneal and conjunctival signs were evaluated.

RESULTS: All six patients exhibited ocular irritation and conjunctival inflammation, while meibomian gland dysfunction (n = 5), rosacea (n = 4), and decreased vision (n = 3) also were noted despite prior treatments with oral tetracycline, topical steroids with antibiotics, and lid scrub with baby shampoo. These patients were proven to have Demodex folliculorum (n = 6) and Demodex brevis (n = 3) by microscopic examination of epilated lashes. Their corneal manifestation included superficial corneal vascularization (six eyes of five cases), marginal corneal infiltration (two eyes of two cases), phlyctenule-like lesion (one eye of one case), superficial corneal opacity (two eyes of two cases), and nodular corneal scar (two eyes of two cases). After treatment, the Demodex count was reduced from 6.8 +/- 2.8 to 1 +/- 0.9 (standard deviation; P = .001). All patients showed dramatic resolution of ocular irritation, conjunctival inflammation, and all inflammatory, but not scarred, corneal signs; three patients showed improved vision.

CONCLUSIONS: A variety of corneal pathologic features together with conjunctival inflammation, commonly noted in rosacea, can be found in patients with Demodex infestation of the eyelids. When conventional treatments for rosacea fail, one may consider lid scrub with tea tree oil to eradicate mites as a new treatment.

See Also: EyeWorld Demodex treatment options

Update: For those interested in how to follow the tea tree oil treatments discussed in this paper, here are some related notes from a page titled Demodex treatment options ;

Dr. Safran said Dr. Tseng’s identification of tea tree oil to treat the Demodex is novel, and he has slightly modified the formulation. While physicians can buy tea tree oil from most health food stores, Dr. Safran has also used an ointment Dr. Tseng is working on. If using the heath food store variety, he said to cut the oil to 50% in Macadamia nut oil.

“I apply it with cotton tip applicators after one drop of tetracaine, so there’s no shield required,” he said. “I am very aggressive with trying to get the oil into the lash roots and along the lashes to kill any eggs. I also aggressively treat the eyebrows. I don’t like the applicator dripping wet, but it should be moist enough so I can see the oil getting onto the skin when it’s touched. I treat the brow first, then the lid to get rid of the excess oil where it won’t irritate as much. I’ll do three applications a visit, about 10 minutes apart, and then finish with a tea tree ointment at 20%, which I have mixed for me at a compounding pharmacy. I do this for three visits, each one week apart.”

Dr. Safran warned other physicians not to use full strength tea tree oil. “I tried that on myself, and it was not a pleasant experience,” he said.
The patient must institute hygiene at home, he said, and that includes tea tree shampoo, scrubs and face wash.

As Tea Tree Oil is a strong substance and your eye is such a sensitive organ, these sorts of therapies really are best undertaken with the supervision of a doctor.

This article also mentions that Dr. Tseng has filed a patent on the use of tea tree oil for ocular use.

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Read more about: demodex mites, natural remedies, ocular rosacea