Mr Walker Consultant Ophthalmologist FRCOphth
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AIM TOTAL ERADICATION OF DEMODEX MITES
Treatment strategy to cure blepharitis
Over the last 12 years or so, I have been recommending the following multi-pronged attack for blepharitis and rosacea patients. I would definitely say it has been my experience that mild and moderate cases can expect to be cured in a matter of a few months; severe cases steadily improve, taking longer - but do get there eventually. Remember mites can live deep in the oil glands.
It needs more than just treating the lids:
a) Ocusoft Plus lid wipes - contain the antiseptic polyaminopropyl biguanide. Comfortable on the lid and kills demodex and bacteria better than all the other commercially available standard cleaning wipes. Costs ~£10 a box online from Amazon (cheapest in bulk), or try via opticians on the high street. Do it thoroughly at night, 30 seconds good scrub each lid when pulled forwards off the eyeball, in the lashes and right on the lid edge. Save money by cutting the wipe into 4 with clean hands, keeping sections in a food bag in fridge. There are some new players on the market selling tea-tree oil wipes, but they may sting, and remain my second line reserve: Optase (with hyaluronic acid, camomile & aloe vera soothing agents, £9.95 a box) or Cliradex (~£32 a box). For eyes which are particularly sensitive, consider a foam dispenser preservative free choice of Steriblef (containing weak tea-tree oil 0.01%, cornflower extract, allantion, and vitamins E & B5, £11 each). Patients with dexterity issues may prefer to try Optase Protect Spray twice daily (hypochlorous acid 0.01%, £9.95). When blepharitis gets significantly better, consider switching over to occasional use of Lumecare wipes (~£5.00 a box), isotonic, biocide and preservative free as maintenance therapy to prevent recurrence.
b) Daily use of Tea tree oil face wash and shampoo. Dr Organic range at Holland & Barrett seems the best strength and quality.
c) If your facial skin isn't too sensitive, I also recommend using neat tea tree oil to the nose, cheeks and forehead last thing at night. It will sting for a few seconds only. The Body shop product is of good quality.
d) Some patients do not like or suit tea-tree oil. An alternative option is Soolantra (Ivermectin 1.0%) cream. A light smear can go on the face and eyelids up to the lash edge (but avoid getting into the eye).
e) For perhaps the most delicate of skins, a final non-medical gentle approach idea is to apply Vaseline on lids and face just before retiring to bed - it may work simply by suffocation.
f) Hot flannels twice weekly. Best if can by using microwave oven on damp flannel for 30 seconds and marigold gloves to carefully lift out - apply to face when can just tolerate heat without scalding self. Repeat cycle for 3-5 minutes. Use a little face wash. A heat bag may be preferred as an alternative; of these, the Clinitas Hot Eye Compress or Optase moist heat mask offer the best functionality and price (also available on NHS prescription). I do not recommend Lipiflow or Meiboflow - to my mind they are no more than just very expensive heat treatments.
g) If you have an especially oily facial skin complexion, try using a little sodium bicarbonate as a facial scrub once or twice a week. Leave on for a bit to act as a mask before rinsing off. It will draw out impurities and unblock glands.
h) Of all the different artificial tears used to comfort such dry eyes, the best seem to be the lipid layer stabilising Systane Balance or Cationorm.
i) Blephex Micro-Dermabrasion procedure for either a boost or especially in severe cases. Nothing can microscopically clean as thoroughly well or as comfortably as this. A great tool for breaking down the toxic biofilm and, in particular, inspissated meibomian gland ducts. It's so new that availability is as yet only on a private basis, via google Blephexlids.
j) Plenty of sunlight exposure, with suncream if needed. I have even wondered about getting patients to sleep with a SAD daylight lamp on for a few months.
Some cases of severe blepharitis induced inflammation do require suppression whilst curative treatment is underway. This can be achieved with:
a) Doxycycline antibiotic tablets. Take 100mg daily for a month, then 50mg daily for 2 months. Occasionally even longer courses are required.
b) Topical steroid eyedrops. If very severe, I use Minims Prednisolone 0.5% QDS for about a month; then maintain on the weaker steroid of Softacort at lowest amount to prevent flare-ups. Monitoring for rare potential steroid side effects of raised pressure and cataract is required.
Please let me know if you are winning! If your symptoms resolve or your ophthalmologist is impressed – it would be worth gathering this data. You may also wish to show your appreciation with a small charitable donation to my Paediatric Clinic Fund - Thank you!