Clinical treatment of ocular demodecosis by lid scrub with tea tree oil

Purpose: To report clinical outcome of treating ocular demodecosis by lid scrub with tea tree oil (TTO). Methods: Retrospective review of clinical results in 11 patients with ocular Demodex who received weekly lid scrub with 50% TTO combined with daily lid hygiene with tea tree shampoo. Results: These 11 patients also had meibomian gland dysfunction (n = 7) manifesting abnormal lipid film with slow lipid film spread, intermittent trichiasis (n = 5), and subjective lash loss (n = 4), suggesting damage to the meibomian glands and lash follicles. In addition, conjunctival inflammation (n = 8) was associated with conjunctivitis (n = 5), conjunctivochalasis (n = 3), findings suspicious for pemphigoid (n = 2), and recurrent pterygium (n = 2). After TTO lid scrub, the Demodex count dropped to 0 for 2 consecutive visits in less than 4 weeks in 8 of 11 patients. Ten of the 11 patients showed different degrees of symptomatic relief and notable reduction of inflammatory signs. Significant visual improvement in 6 of 22 eyes was associated with a stable lipid tear film caused by significant reduction of lipid spread time. Lid scrub with 50% TTO caused notable irritation in 3 patients. Conclusion: Demodex potentially causes ocular surface inflammation, meibomian gland dysfunction, and lash abnormalities. Lid scrub with TTO can effectively eradicate ocular Demodex and result in subjective and objective improvements. This preliminary positive result warrants future prospective investigation of Demodex pathogenicity.