Overgrowth of Demodex can initiate damage across the lids and over the lashes that, left untreated, could result in ocular surface disease, Cecilia Koetting, OD, explains. Here, she explains methods for determining when Demodex is creating damage and what optometrists can do to repair it and prevent it from continuing. Check this month’s video for a detailed explanation of her diagnostic techniques, such as proper patient positioning during a slit lamp evaluation, and a demonstration of the cylindrical dandruff at the base of the eyelids that accompany these microscopic mites. She also performs a blepharo-exfoliation procedure using a tea tree gel and discusses the benefits of using a manuka honey solution as an alternative.