Treatment options for demodex blepharitis: patient choice and efficacy

Klin Monbl Augenheilkd. 2015 Apr;232(4):384-7. doi: 10.1055/s-0035-1545780. Epub 2015 Apr 22.


Background: Demodex mites are microscopic parasites that live around hair follicles or sebaceous glands and may cause chronic blepharitis. The aim of this outcome analysis was to assess the efficacy and patient preferences with regard to the currently recommended treatment options.

Methods: All patients with microscopic evidence for Demodex blepharitis were informed about the currently published treatments and instructed about daily lid hygiene. Additional topical treatment options included tea tree oil (TTO) 5%, a cleansing foam containing 0.02% TTO (Naviblef®), and metronidazole 2% ointment. Systemic treatment options included oral ivermectin 6 mg on day 1 and 14 and metronidazole 500 mg twice daily for 10 days. All patients were reviewed after 2 months for symptoms and for a mite count on 10 epilated lashes.

Results: Ninety-four of 96 patients with Demodex blepharitis opted for an additional treatment. The mean mite count after 2 months of treatment were 13.3 with 5% TTO (n=6), 12.0 with 0.02% TTO (n=38), 9.4 with metronidazole ointment (n=5), 12.8 with ivermectin (n=27) and 22.0 with oral metronidazole (n=5).

Conclusion: While there are several published treatment options available, none of these options seem to be clearly effective in Demodex blepharitis.

MeSH terms

  • Acaricides / administration & dosage*
  • Acaricides / classification
  • Antiparasitic Agents / administration & dosage
  • Antiparasitic Agents / classification
  • Blepharitis / diagnosis*
  • Blepharitis / drug therapy*
  • Blepharitis / parasitology
  • Drug Administration Schedule
  • Female
  • Humans
  • Male
  • Mite Infestations / diagnosis*
  • Mite Infestations / drug therapy*
  • Mite Infestations / parasitology
  • Patient Preference*
  • Retrospective Studies
  • Treatment Outcome


  • Acaricides
  • Antiparasitic Agents