Anti-Demodectic Treatments Often Yield Discomfort, Vary in Tolerability Profiles

MUNICH, GERMANY – NOVEMBER 26: Demodex mite (Demodex gatoi) in the institute for parasitology of the Ludwig-Maximilians-University Munich on November 26, 2003 in Munich, Germany. (Photo by Agency-Animal-Picture/Getty Images)
Applying 1 anti-demodectic product with an unspecified concentration of tea tree oil resulted in significant changes in ocular redness, corneal and conjunctival staining, and lid wiper epitheliopathy grade 10 minutes after application.

Commercial, anti-demodectic eyelid cleansers are likely to yield initial discomfort, with varying tolerability profiles for different products, according to research published in Contact Lens and Anterior Eye. 

Researchers enrolled 30 participants (mean age, 33±12 years; 18 women) in a prospective, randomized, crossover analysis to evaluate the short-term tolerability of 5 eyelid cleansers designed to help manage Demodex. Participants were randomized to 1 of the 5 topical treatments or saline solution, and best-corrected visual acuity (BCVA), noninvasive tear film stability, conjunctival hyperemia, and ocular surface staining were assessed at baseline and 10 minutes following initial application. Participants subjectively graded comfort levels with each product and attended a total of 7 visits, (1 enrollment and 6 treatments) with each visit separated by 48 to 72 hours. 

Overall, discomfort persisted for 60 seconds or more following topical application of all 5 products (P <.05 for all) and no significant changes in visual acuity occurred from the time of application to 10 minute follow-up (P ≥.63 for all). Tear breakup time (TBUT) decreased in 4 of the 5 products, and was statistically significant in only 1 product with an undisclosed tea tree oil concentration (8.9±4.4 to 5.6±3.1; P <.001). Researchers note increases in bulbar and limbal conjunctival redness, increased corneal and conjunctival staining, and increased superior and inferior lid wiper epitheliopathy scores for the same product from baseline to 10 minute follow-up with the same product (P ≤.03 for all). They did not observe any statistically significant differences in these parameters with any of the other topical treatments during the 10 minute interval. 

The investigators assert that while topical, anti-demodectic applications will likely cause discomfort, patient education is critical in ensuring optimal outcomes. 

“These findings might help to inform patients surrounding possible adverse effects that might arise from the topical application of commercial anti-demodectic lid cleansers,” according to the researchers. “Basing clinical recommendations on scientific evidence promotes the setting of realistic patient expectations and may encourage better long-term compliance.”

Study limitations include a small sample size and the use of nonspecific ocular discomfort measurements. 


Craig JP, Bitton E, Dantam J, Jones L, Ngo W, Wang MTM. Short-term tolerability of commercial eyelid cleansers: A randomised crossover study. Cont Lens Anterior Eye. Published online July 13, 2022. doi:10.1016/j.clae.2022.101733