Can Demodex Mites Cause Blepharitis?

by | Dec 22, 2018 | Health of Skin and Hair | 1 comment

Blepharitis is a commonly progressive chronic illness considered one of the most found ocular disorders in clinical practice.

Blepharitis is one of the most common ocular disorders seen by eye care specialists and is found in almost 47% of ophthalmic patients. Approximately 30 million Americans may be affected.1 Blepharitis is common in middle-aged patients, and its incidence increases with age.

The physiopathology is not entirely known and it represents a therapeutic and diagnostic challenge. Different factors are involved in the pathogenesis of chronic blepharitis, including alteration of the ocular microflora, reaction to exotoxins, allergic response to antigens, changes in the dynamics of the tear film and dysfunction of the meibomian gland.



Diagnosis of anterior blepharitis is typically based on signs, symptoms, history, and external/lid examination. Typically bilateral, anterior blepharitis is both chronic and intermittent and can significantly impact quality of life.1 In its acute phase, patients often present with bright red, puffy, irritated eyes that itch or burn. 3 Additional signs include lid and lash debris, watery eyes, and intermittent effects on vision.

  • Watery eyes:

watery eye | UnegxWatery eyes can be due to many factors and conditions. In infants, persistent watery eyes, often with some matter, are commonly the result of blocked tear ducts. The tear ducts don’t produce tears, but rather carry away tears, like how a storm drain carries away rainwater. Tears normally drain into your nose through tiny openings (puncta) in the inner part of the lids near the nose.

In babies, the tear duct may not be fully open and functioning for the first several months of life. In older adults, persistent watery eyes may occur as the aging skin of the eyelid’s sags away from the eyeball, allowing tears to accumulate and flow out. Sometimes, excess tear production may cause watery eyes as well. Allergies or viral infections (conjunctivitis), as well as any kind of inflammation, may cause watery eyes for a few days or so.


  • Red eyes: 

bloodshot eye header | UngexHaving red eyes most or all of the time indicates inflammation of the eye’s tissues due to irritation, infection, disease or allergy. When your eyes are red, this means blood vessels in the eye are dilated to increase blood flow to inflamed tissues. Extra blood is necessary to counter inflammation because blood carries white blood cells meant to fight inflammation.

Some reasons for chronically red eyes are obvious, such as seasonal allergies, colds, influenza and conjunctivitis (pink eye). Other reasons may not be obvious because symptoms of certain eye conditions are often disregarded or attributed to something else.




Blepharitis is a common chronic cause of eyelid disease. Its pathogenic mechanisms are not fully known, but it is attributed to a range of factors including chronic ocular surface low degree infection caused by bacteria, infestation of some parasites such as D. folliculorum, Demodex mites and inflammatory conditions that give rise to Meibomian glands dysfunction.

Demodex mites have been associated with blepharitis and several pathological mechanisms have been suggested. The mites can cause a direct damage in the epithelial cell at the lash follicle, induce a reactive hyperplasia and hyperkeratinization or mechanically block of the orifices of meibomian glands. Bacteria were found inside and on the surface of Demodex mites. Some of them, such as staphylococci, produce exotoxins that can directly contribute to unspecific irritative symptoms or induce a host immune reaction. In addition, proteins of the mites and their debris may also elicit a host delay hypersensivity reaction.

Various reports of Demodex infestation in association with acquired immunodeficiency syndrome and cancer chemotherapy and the higher prevalence of Demodex in potential immunosuppressed subpopulations, such as pregnant and hemodialysis patients, have suggested that immunological deficiency may facilitate the overgrowth of the mites. Patients with diabetes have an increased risk for infections, but the exact mechanisms of the immunocompromised state are unclear.

Several abnormalities might contribute to the increased susceptibility and severity of infections in diabetic patients, including lower chemotactic activity of neutrophils, reduced function of mastocytes, poor leukocyte-endothelial cell interactions and decreased quantity of leukocytes in inflammatory lesions, low oxidants compounds generation, a reduction in lymph node retention capacity and reduced release of cytokines, such as tumor necrosis factor alpha, interleukins and prostaglandins.



  1. Differentiate and understand presentation differences:
    The first step in addressing blepharitis is to differentiate and understand the differences among the presentations. The term “blepharitis” has been commonly referred to as a single disease state; however, there are multiple presentations which are not the same at all. To complicate things further, there is inconsistency in terminology in addition to challenges related to overlap with other ocular surface diseases such as dry eye disease and allergic conjunctivitis. All three may present with similar signs and symptoms which, if not properly identified, will not be optimally treated.
  2. Understand the prevalence and who is affected:
    The second step in addressing blepharitis is to appreciate why it matters and who is affected. As optometrists, we are judged by the ocular comfort and quality of vision for our patients. We understand that ocular surface disease, including dry eye disease, ocular allergy, and both anterior and posterior blepharitis, plays a role.
  3. Listen to patient complaints and look for the disease:
    The third step in blepharitis management is listening to our patients’ complaints and looking for the disease—even if they do not present with symptoms. Whether patients present for a routine evaluation, contact lens fitting, surgical evaluation, or something else, a thorough evaluation of the lids and the ocular surface must be performed in order to promote and address the ocular health and surface. Blurred and fluctuating vision can affect all our patients and can lead to remakes of glasses. Contact lens wearers want to be able to wear their lenses comfortably throughout the day, and all forms of blepharitis can lead to contact lens dropouts due to this discomfort. Blepharitis can also lead to the increased risk of ocular infections and inflammatory conditions such as contact lens-related red eye, marginal keratitis, and corneal ulcers.
  4. Eat and manage accordingly:
    Goals for the treatment and management of all forms of blepharitis include reducing the symptoms and signs, minimizing structural damage, and preventing loss of visual function.To accomplish these goals, providers must identify the condition, determine the severity, and treat accordingly. Patient education is key to treatment for any ocular or medical condition, including blepharitis. Patients must understand that this is their condition and there is no cure; however, we are going to help them manage it.17 Warm compress, eyelid hygiene, nutraceuticals, topical/oral antibiotics, and topical anti-inflammatories have been the traditional mainstay of treatment. Showing patients how to properly use each treatment will help with compliance and adherence.


Get a long-term solution for Demodex mites 

Ungex’s protocol is a total care plan that will be tailored to you and your lifestyle. If you follow the care plan provided to you with the products, you’ll be surprised how successful your treatment will be. If you want to ensure you stay Demodex-free, we recommend shampoos and other products individually so you can keep the mites away.


First step is to take Ungex unique Demodex detection test which is an online form that will take only 10 minutes to complete.

After that, Ungex consultants will contact you to take you through further steps.


You can get more information here or by visiting our forum.

Share this post:
Tags: , ,