Background: Demodex folliculorum has been an underscored cause of anterior blepharitis causing symptoms of ocular discomfort and itching along the eyelid margin. Diluted tea tree oil (TTO) has been promoted as an effective natural ingredient in the management of demodicosis, an infestation of the Demodex mite. More recently, an eyelid cleanser with hypochlorous acid (HOCl) reports effectiveness against anterior blepharitis with strong antimicrobial properties. This case report highlights 2 cases of patients with recalcitrant demodicosis which have had limited success with TTO and placed on HOCl-based lid cleanser for a 2 week treatment.
Case report: A 59 yr old female was referred for chronic blepharitis and a dry eye (DE) workup revealed mild symptoms, (OSDI 18/100), mainly itching, poor stability (TBUT 4 sec) and a severe Demodex infestation. The patient was given a 6 wk treatment with TTO-based eyelid cleansers (Theralid and Cliradex), which improved symptoms (OSDI 6), but mildly improved the presence of cylindrical dandruff (CD). A second patient, 30 yr old female, was referred for chronic DE, which revealed severe symptoms (OSDI >45/100) and positive for Demodex. Pulse dosing with Cliradex improved symptoms but failed to reduce the CD load even after 1 yr of use. Both patients were put on a HOCl cleanser (Avenova) whereby a noticeable reduction in CD load was noted after only 2 weeks. Patients found the HOCl cleanser more tolerable than the TTO-based ones.
Conclusion: Ocular discomfort is one of the principal complaints reported to eye care practitioners (ECP). Dryness is usually at the forefront of the differential diagnosis (DDx) when epiphora and discomfort are reported. ECPs should additionally consider Demodex in their DDx and consider both TTO and HOCl-based cleansers as treatment options.