Why Treat Demodex?
Demodex in small numbers don’t necessarily need to be treated, but when they are present in large numbers (an overpopulation or an infestation) they can cause significant, irreparable damage to your eyelashes, eyelids, and the glands in your eyelids known as Meibomian glands.
This is why diagnosing and properly treating this condition early on is so important.
In addition, demodex can cause or exacerbate conditions such as dry eye, styes, chalazia, blepharitis, Meibomian gland dysfunction, ocular rosacea, and rosacea involving your face.
Treating Demodex
There are two in office treatments that Dr. Muller can perform to facilitate the eradication of your mites:
1. A BlephEx™ treatment is a comfortable in-office procedure performed by Dr. Muller using a revolutionary new patented medical device which employs a high-speed rotating micro-sponge soaked in an eyelid cleanser containing tea tree oil to deep clean and exfoliate your eyelids and eyelashes. This procedure thoroughly removes the debris and other remnants of your demodex mites, while clearing the biofilm* from your eyelids.
A numbing drop is placed in each eye prior to treatment. The procedure lasts about 6 -8 minutes, is comfortable and effective.
When a Blephex treatment is performed immediately prior to an in office deep cleanse (below), the Blephex treatment increases the effectiveness of the deep cleanse by increasing the penetration of the medical grade tea tree oil into the Meibomian glands, and the eyelash and eyebrow follicles.
2. An in office deep cleanse and debridement can be performed by Dr. Muller using a highly concentrated medical grade tea tree oil. The highly concentrated tea tree oil applied during this in office medical treatment is not suitable for home use (it's too strong/caustic).
A Blephex debridement immediately followed by a deep cleanse using highly concentrated medical grade tea tree oil is the most rapid, most effective way to kill both the adult demodex mites and their larvae (eggs).
Xdemvy:
Xdemvy is the first FDA-approved eye drop for the treatment of Demodex eyelid mites. Its active ingredient, lotilaner, targets and kills Demodex mites alleviating eyelid inflammation, irritation, redness, and crusting.
Xdemvy is administered as a topical eye drop, applied twice daily in each eye for a 6-week course.
Intense Pulsed Light (IPL) Therapy:
While there are many IPL devices, there’s only one that's FDA approved specifically for the treatment of dry eye and Meibomian gland dysfunction, and it also kills Demodex. OptiLight by Lumenis was specifically designed to reach the delicate contours around the eyes. It uses patented state-of-the-art Optimal Pulse Technology (OPT) to deliver a safe, comfortable, effective in office treatment for dry eye, Meibomian gland dysfunction (MGD), blepharitis, styes (hordeola), chalazia, ocular rosacea and Demodex.
Intense Pulsed Light (IPL) therapy has been used in dermatology for decades demonstrating a long history of safety and efficacy. The first Intense Pulsed Light (IPL) device became available commercially in 1994 for use in the treatment of rosacea and acne. In 2015 Intense Pulsed Light (IPL) was used for the first time to treat dry eye and Meibomian gland dysfunction (MGD).
In combination with other treatments, Intense Pulsed Light (IPL) therapy can achieve long lasting relief of symptoms and slow, or stop, the progression of dry eye disease, Meibomian gland dysfunction (MGD), blepharitis, styes (hordeola), chalazia, ocular rosacea and Demodex.
How Does Intense Pulsed Light (IPL) Therapy Work?
Intense Pulsed Light (IPL) therapy successfully treats Demodex by directly killing the mites.
Intense Pulsed Light (IPL) therapy treats dry eye disease, Meibomian gland dysfunction (MGD), blepharitis, styes (hordeola), chalazia, and ocular rosacea by improving the health and functioning of damaged blood vessels in the area.
Inflammation is the underlying cause of dry eye (keratitis sicca) and a major component of Meibomian gland dysfunction. This inflammation harms blood vessels in the area causing them to dilate and rendering them hyperpermeable, or leaky, releasing plasma* into the surrounding tissue. The plasma released into the tissue contains pro-inflammatory mediators which fuel a vicious cycle of inflammation adversely affecting the health and comfort of the eyes and eyelids.
Intense Pulsed Light (IPL) utilizes light energy of specific wavelengths to precisely target the leaky, damaged, dilated blood vessels in the skin around the eyes rendering these vessels healthier. Inflammation in the area is dramatically reduced by stimulating constriction of dilated blood vessels and suppressing their leakage. IPL reduces inflammation by breaking the cycle of inflammation.
This reduction of inflammation allows for recovery of the Meibomian glands in both form and function, improves the quality of the tear film, enhances tear film stability, reduces evaporation of the tears from the surface of the eyes, and improves ocular lubrication, thus improving dry eye signs and symptoms. In addition to making patients much more comfortable, IPL therapy can also reduce reliance on medications. Lastly, Intense Pulsed Light (IPL) therapy stimulates collagen production in the skin which can improve the overall health and appearance of the eyelid area and surrounding tissues.
*The plasma which leaks from damaged blood vessels contains pro-inflammatory mediators including, but not limited to, vascular endothelial growth factor (VEGF), prostaglandin E2 (PGE2), and pro-inflammatory cytokines.
What To Expect on The Day of, and Following, Your Intense Pulsed Light (IPL) Treatment:
On the day of your treatment you can eat and drink normally.
Please do not wear any make-up on the day of your treatment. You can bring your makeup with you and apply it after your treatment.
Anesthetic eye drops will be placed in your eyes. Your eyes will then be covered with protective shields. This will be followed by the application of a thin layer of cooling gel to the area being treated (similar to the gel used for ultrasounds). Next, a handheld Intense Pulsed Light (IPL) device will be used to deliver gentle pulses of light.
A typical Intense Pulsed Light (IPL) treatment session for dry eye, Meibomian gland dysfunction (MGD), blepharitis, styes (hordeola), chalazia, ocular rosacea, and/or Demodex lasts about 10-15 minutes.
Cold gel packs are then applied to the treated area.
There may be some redness, a warm sensation, and slight inflammation in the treated area which, if present, typically disappears in 1-72 hours.
There are no restrictions on activities following the treatment; patients can resume their normal activities as no downtime is required.
To ensure the best results you must protect your skin from the sun. Following your IPL treatment it's essential to protect your skin from direct sun exposure for the first 72 hours and apply paraben-free sunscreen (SPF 30 or more) several times a day. Applying sunblock and moisturizer should be/become part of your daily routine.
Please follow the post-treatment regimen Drs. Malawer and Muller provide.
Treatment Schedule:
The treatment protocol needed to achieve optimal results includes 4 treatment sessions spaced 2-4 weeks apart. While some patients report improvement after 2 or 3 sessions, maximum improvement is achieved after 4 treatments. Improvement in both the way you feel and look generally takes place gradually over weeks. The frequency of subsequent maintenance treatments varies from person to person, however, are generally performed every 6-12 months to ensure long-term benefits. Your custom treatment plan will be individualized and tailored to your personal needs.
Intense Pulsed Light (IPL) Therapy’s Safety Over Decades Has Been Established in the Treatment of:
Skin rejuvenation: Improving skin tone and texture. Reducing fine lines, wrinkles and signs of aging by stimulating collagen production thus giving skin a firmer, more voluminous, youthful appearance.
Ameliorating unwanted pigmentary changes, sunspots, age spots, and sun damage.
Rosacea and vascular lesions (spider veins, broken capillaries).
Enlarged pores by reducing pore size.
Treating acne by targeting the bacteria (p. acne) that causes breakouts and reducing inflammation.
Treating acne scars.
In addition to the in-office treatments above, all patients are given the following instructions for continued at home treatment:
- Wash all sheets, pillowcases, and towels in hot water and dry with the “high” dryer setting.
- Discard all pillows.
- Discard all old makeup and refrain from wearing makeup until the mites are eradicated.
- If you sleep with a partner, he or she must be evaluated for Demodex.
- Purchase and use tea tree soap for your face, and tea tree shampoo for your hair.
- Purchase wipes (towelettes) and foam containing Tea Tree oil and cleanse your eyelids twice each day using them.
-
- Cliradex Demodex Cleansers (4% terpinen-4-ol, an isolated component of tea tree oil): https://cliradex.com/
-
- Start Xdemvy (lotilaner opthalmic solution) prescription eye drops twice daily for 6 weeks. Xdemvy is an anti-parasitic which kills Demodex mites by paralyzing them. https://xdemvy.com
- Use a prescription ophthalmic ointment, as directed, to smother the Demodex mites and impede their movement when they come out at night to mate and eat on your eyelids (they're nocturnal).
*A biofilm is a slimy, sticky film of bacteria that coats the surface of the eyelids. A biofilm is composed of a well-hydrated matrix of bacteria and their glycocalyx, a sugary coating that allows cells to adhere to and communicate with each other. The eyelid margin with its moisture, nutrients and warmth, is the perfect environment to cultivate a thriving bacterial biofilm. Some people experience an increased frequency of accumulation of a tenacious biofilm along their eyelid margins. These individuals benefit from periodic exfoliation of their eyelids to keep their Meibomian gland orifices (openings) uncapped of unclogged. This helps ensure the health of the Meibomian glands, decrease irritation and inflammation, and keep the eyes and eyelids their healthiest and most comfortable.
