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Cliradex Effectively Eliminates Demodex, a Common Cause of Treatment-resistant Blepharitis
By Brandon D. Ayres, MD
In my cornea and external disease practice with a tertiary care group, blepharitis is one of the most common diagnoses. By the time patients with
blepharitis are referred to me, often they’ve already been treated with a number of options yet the condition persists. In this scenario, Demodex is always
among the potential underlying causes I consider.1
Demodex, a microscopic parasite found on the skin, doesn’t necessarily cause problems. However, when these tiny mites multiply, they infest hair follicles
and oil glands, including those of the eyelids. The result is inflammation and other symptoms, such as foreign body sensation, itching, burning, red eye,
dryness and blurry vision, which are also seen in many other ocular surface disorders. That said, there are some clinical findings that help to
differentiate Demodex. Two classic findings are waxy collarettes called cylindrical dandruff at the base of eyelashes and seeing the mites themselves
attached to the cilia (typically at the base). The mites and cylindrical dandruff combined with lid margin redness and conjunctival injection are very
indicative of Demodex infestation. Sometimes it’s possible to actually see the mites at the eyelid margins or on the periocular skin at the slit lamp, but
I also remove a few of the patient’s eyelashes and look at them under a microscope to confirm the presence of the mites. Also, showing the mites to
patients helps to solidify in their minds the diagnosis and importance of treatment. Demodex is often the culprit in patients, particularly patients with
rosacea, whose blepharitis, either anterior, posterior or both, hasn’t responded to traditional treatments including azithromycin or doxycycline.
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The goal of treating Demodex is to eradicate the mites. While good eyelid hygiene with the help of lid wipes is beneficial in all types of blepharitis
because it removes bacteria-harboring, inflammation-causing debris, I’ve found Cliradex (Bio-Tissue, biotissue.com) to be particularly effective against
Demodex. Cliradex is a natural, preservative-free lid, lash and facial cleanser.2,3 Cliradex contains a specific component of tea tree oil —
4-Terpineol — which studies have indicated has a more potent miticidal effect than tea tree oil as a whole.4 Researchers theorize that
4-Terpineol alone is so potent because it reduces the adverse and antagonistic effects of other components of tea tree oil. Additionally, 4-Terpineol has
been scientifically proven to eliminate Demodex.
When I first began recommending Cliradex for my Demodex-blepharitis patients, I did so only when I had confirmed the condition under the microscope. I’ve
since changed that approach and now recommend Cliradex whenever I suspect Demodex because I’ve found no downside in doing so. It is safe to use every day
and has been very effective in eliminating signs and symptoms. I advise patients to use a Cliradex towelette once in the morning and once in the evening
for 2 weeks and then once a day thereafter until I see no signs of Demodex-blepharitis. Proper cleansing must include the eyelids, eyelid margins,
eyelashes and the entire periocular area, as well as keeping each eye closed for a minute while the areas air dry. Patients are always highly motivated to
rid themselves of Demodex and with Cliradex they experience results quickly, which means they tend to comply with my recommendations for usage.
References
1. Liu J, Sheha H, Tseng SC. Pathogenic role of Demodex mites in blepharitis. Curr Opin Allergy Clin Immunol. 2010;10(5):505-510.
2. Carson CF, Hammer A, Riley TV. Melaleuca alternifolia (tea tree) oil: a review of antimicrobial and other medicinal properties. Clin Microbiol Rev. 2006;19(1):50-62.
3. Gao Y-Y, Di Pascuale MA, Li W, et al. In vitro and in vivo killing of ocular Demodex by tea tree oil. Br J Ophthalmol. 2005;89:1468-1473.
4. Tighe S, Gao Y-Y, Tseng SCG. Terpinen-4-ol is the most active ingredient of tea tree oil to kill Demodex mites. Trans Vis Sci Tech.
2013;2(7):2.
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Brandon D. Ayres, MD
Dr. Ayres specializes in cornea and external disease, practicing with the Cornea Service at Wills Eye Institute in Philadelphia and the Wills-affiliated Ophthalmic Partners of Pennsylvania.
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