Blepharitis (Eyelid disease): Conventional and Holistic Approaches

Blepharitis is more common than we thought, can be quite serious, thus, preventive vigilance is called for.  In this HMI Disease Analysis, I will first examine what blepharitis is and its symptomatology (Section A). Thereafter, I will analyze causation (Section B) and conclude with an examination of both conventional and holistic treatment plans to resolve this eye disorder. (Section C).

Section A

Nature of the Disease & Symptomatology

Blepharitis is a relatively common inflammatory condition of the eyelid margins. We all have bacteria on the surface of our skin. But for some people, the bacteria thrives at the base of the eyelashes.. It can be painful, irritating and even itchy. And for some people, blepharitis can lead to more severe consequences like blurred vision, inflammation of eye tissue, loss of vision and even eyelid cancer. Thus self-cared is recommended and all the more so that this condition is likely to be the most under-diagnosed, undertreated, and underappreciated eye disease worldwide. (1)

The symptoms of blepharitis can vary depending on the cause, type and severity of the condition. (Source) The most common symptoms of blepharitis include burning sensation, tearing, irritation, red eyes, blurred vision, missing eyelashes, sticking eyelids, flakes or scales around the base of the eyelashes, hard crusts around the eyelashes and inflammation of eye tissue (especially the cornea). According to the National Eye Institute,  Blepharitis occurs in two forms:

Complications associated with blepharitis?

Complications from blepharitis include, but are not limited to the following: Stye: A red tender bump on the eyelid that is caused by an acute infection of the oil glands of the eyelid. Chalazion: This condition can follow the development of a stye. It is a usually painless firm lump caused by inflammation of the oil glands of the eyelid. Chalazion can be painful and red if there is also an infection. Ocular rosacea can also be a complication emanating from Blepharitis. This disease also affects the eyes and eyelids. Although medical experts are still debating on  what causes rosacea, there are shared pathways and common pathogens between the two diseases.While rosacea is considered a skin condition, it affects the eyes in 58 to 72 percent of cases and is triggered by an overactive immune system. Research shows that about one-third of patients with ocular rosacea develop potentially sight-threatening inflammation of the cornea. (Source)

Another complication: Problems with the tear film: Abnormal or decreased oil secretions that are part of the tear film can result in excess tearing or dry eye. Because tears are necessary to keep the cornea healthy, tear film problems can make people more at risk for corneal infections. Irregular oil secretions that result from debris or flakes accumulating in the tear film can lead to excess tearing. Decreased oil secretions that are caused by an abnormality with the meibomian glands can affect the amount of oil intears and lead to dry eye. Touching and rubbing the infected area of the eyelid can cause a secondary infection because of the spread of bacteria. It’s important to avoid touching or rubbing one’s eyes if hands are not clean. When left untreated, blepharitis can cause misdirected eyelashes, meaning they grow abnormally, or cause your eyelashes to fall out. Patients with longstanding chronic blepharitis may present hypertrophy of the lid margin, scars, madarosis, trichiasis, and poliosis.  For more details on this disorder, See National Eye Institute (Source)

Section B

General Considerations and Pathophysioloty (etiology)

Diagnostic Challenges

In the past, the terminology of blepharitis has been vague but over the past few years, the International Workshop on Meibomian Gland Dysfunction have produced a series of publications aimed to clarify the classification and summarise the literature on etiology, pathophysiology, and treatment.(123)

However, from the viewpoint of conventional medicine,  blepharitis remains a diagnostic enigma, with a variety of treatments with variable levels of efficacy, reflecting the poor understanding of etiology.

Risk Factors

People who use too much eye make-up (especially non organic), who have oily skin, dry eyes, rosacea or dandruff are at a greater risk of developing blepharitis

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Top: Eyelid margin examination reveals inspissated (thicken) glands (arrows) in meibomian gland dysfunction. These glands produce lipids that help to lubricate the eyes and keep them protected from the environment. On occasion they can get clogged.

 Causation

Anterior blepharitis

Anterior blepharitis  affects the outside front of the eyelid, where the eyelashes are attached. The two most common causes of anterior blepharitis are bacteria (Staphylococcus) and scalp or eyebrow dandruff (called seborrheic blepharitis). When these bacteria around the face and eyelids begin to grow and become excessive, or the eyelid overreacts to their presence, an infection may occur. The bacterial growth associated with anterior blepharitis is commonly due to poor eye hygiene. This allows bacteria to live and grow in the folds and crevices of the eyelids. The bacteria causes inflammation, redness, burning and stinging around the eyelid.  (Source)

Although less common, allergies or a mite infestation of the eyelashes can lead to anterior blepharitis. If one is allergic to the bacteria or chemicals that are used on the eyes (like those found in eye makeup or lotions),  blepharitis symptoms can develop.

An eyelash mite called demodex can also infest the eyelid margins and eyelashes, causing irritation and redness. Although demodex mite infestation usually remains asymptomatic, when they are present in high densities or affect someone with an immune imbalance, they can cause a range of dermatological conditions, including blepharitis. (Source)

Posterior blepharitis

Posterior blepharitis affects the inner eyelid (the moist part that makes contact with the eye) and is caused by problems with the oil (meibomian) glands in this part of the eyelid. Two skin disorders can cause this form of blepharitis: acne rosacea, which leads to red and inflamed skin, and scalp dandruff (seborrheic dermatitis). When the glands of the eyelids irregularly produce oil, this creates a favorable environment for bacterial growth and infection. It also affects the stability of your tears because without the oily layer in tears, they evaporate quickly and can cause dry eyes. Skin conditions like ocular rosacea and scalp dandruff can also cause posterior blepharitis.

The Eyelid’s Microbiota

In  this perspective, Dadaci et al (4) investigated the microbial flora of the eyelid margin and showed excessive microbial colonisation of the lids in patients with blepharitis. The authors found that fungal elements were detected with periodic acid-Schiff staining in approximately four out of five patients with chronic anterior blepharitis. (4)

Fungi, specifically Pityrosporum yeasts, have been implicated in blepharitis as early as in 1990; in a placebo-controlled clinical trial, published in Eye, treatment with ketoconazole 2% cream on the lid margins markedly improved the clinical severity of blepharitis. (5) Coagulase-negative Staphylococcus, Staphylococcus aureus, and Propionibacterium acnes are common commensal microbes that may contribute to the pathophysiology of blepharitis. (6)

Dadaci et al, (4) also found that there were high levels of Demodex infestation. Other investigations of Demodex show that infestation of lash follicles is associated with the occurrence of anterior blepharitis. (7)

In a large study involving 335 patients, the number of Demodex mites correlated significantly with the severity of ocular surface discomfort.

However, the presence of microbes on the lid margin of patients with blepharitis does not imply causality. Excessive colonisation may be an epiphenomenon, indicating the possibility that microbes find the altered eyelid environment in blepharitis more hospitable than that of the normal eyelid.

Keratinisation of the lid margin epithelium, keratinised cell debris, and the abnormal lipids in blepharitis all provide a rich substrate for microbial pathogens.(1)

It must be emphasised though that this alteration of conjunctival microbial flora does not represent an infection. In addition, the matter is made more complex in the presence of posterior blepharitis where the primary aetiology is the occurrence of meibomian gland dysfunction.

Irrespective of whether fungi, bacteria or other pathogens are the primary cause of blepharitis, there is strong suspicion that excessive microbial colonisation contributes to the pathophysiology of the condition. Bacterial lipases and toxins could alter the lipid composition and destabilise the tear film, with the production of toxic-free fatty acids, causing evaporative dry eye. (10) The secondary production of pro-inflammatory cytokines, neutrophil chemotaxis, and reactive oxygen species production are all pathogenic to the ocular surface. (1)

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Top: Eyelash and eyebrow demodex mites that live in hair follicles

Parasitic Mites that live in Eyelashes And Eyebrows Hair Follicles and sebaceous glands

Of the 64 different parasitic mites called Demodex that infect mammals’ eyelashes and eyebrow, two are present in most humans. (See picture above).  Demodex folliculorum tends to be clustered to the hair follicle roots of the eyelashes while demodex brevis tends to thrive in sebaceous and meibomian glands connected to hair follicles. Both species are primarily found in the face, near the nose, the eyelashes, and eyebrows, but they can  also burrow in other parts of the body.

Their bodies are covered with scales which they use to attach themselves to your eyebrow and eyelash hair follicles, their favorite niches. They feed on sebum as well as skin cells using a pointed mouth like structure and when in small population, eyebrow-eyelash mites and humans have s symbiotic relationship where they help in eating the excessive sebum oils that the body produces. (Source)

Although these demodex critters  are considered commensals and harmless when in small amounts,  when they start producing symptoms, they become nefarious parasitic. Like with the entire microbiota, it’s all about balance.

These inflammatory symptoms often happen when the person is chronically stressed, has a weakened immune system and an unhealthy lifestyle,  at which point these mite populations can dramatically increase and promote human itching, inflammation, and other skin disorders like Blepharitis (inflammation of the eyelids and loss of eyebrows and eyelashes). (Source A and B). 

The Demodex’ bodies are covered with scales for anchoring themselves in the hair follicle, and these mites have pin-like mouthparts for eating skin cells and oils (sebum) which accumulate in the hair follicles. The mites can leave the hair follicles and slowly walk around on the skin, at a speed of 8–16 cm (3.1–6.3 in) per hour, especially at night, as they try to avoid light. (Source).

Females of D. folliculorum are larger and rounder than male. (Source) Mating takes place in the follicle opening, and eggs are laid inside the hair follicles or sebaceous glands. The six-legged larvae hatch after three to four days, and the larvae develop into adults in about seven days. The total lifespan of a Demodex mite is several weeks. They can also carry with them different bacteria.

A study of 29 adults (18 and over) in North Carolina, US, found that 70% of those 18 years of age carried mites, and that all adults over 18 (n = 19) carried them  (Source) However, the small sample size and small geographical area involved prevent from drawing broad conclusions from these data.

Be that as it may, to durably revolve skin and eye disorders like blepharitis, we can not ignore these mites as they appear to be the primary source of eyelid inflammation as well as eyebrow and eyelashes thinning and loss.

Section C

Conventional Treatment

Blepharitis treatment depends on the cause of the condition. Conventionally, blepharitis treatment is aimed at preventing irritation to the surfaces of the eyes and controlling inflammation. Patients with chronic blepharitis are often treated with antibiotics and steroid drops, a treatment that may also alter the resident commensal flora and favour excessive colonisation with selective bacterial or fungal microbes.

Artificial tear solutions or lubricating ointments are sometimes prescribed to reduce irritation to the eyes and eyelids. To treat ocular rosacea, a leading cause of blepharitis, topical and systemic anti-inflammatory drugs are commonly prescribed. Corticosteroids are also used to improve the symptoms of blepharitis, especially when combined with topical antibiotics. Although this combination can bring on a quick relief of symptoms, long-term use can lead to some harmful side effects. (Source)

Some topical antibiotics that are commonly prescribed include erythromycin or bacitracin ointment. These are applied directly to eyes with eyedrops or by wiping the ointment across the closed eyelid near the eyelashes. Tetracycline is an antibiotic that’s often used to fight a bacterial infection that’s causing blepharitis. Tetracycline is used to treat bacterial infections of the skin and other body systems, such as the urinary tract, genitals and respiratory system. Taking tetracycline can lead to common side effects, including nausea, vomiting, upset stomach, diarrhea and sores or swelling. This medication should not be taken by children under the age of 8 or women who are pregnant or breastfeeding. (Source)

Researchers have also noted that taking antibiotics to treat blepharitis may alter the patient’s flora and favor excessive colonization of bacterial and fungal microbes. This increases the likelihood of developing blepharitis (and other conditions) again. (Source)

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Top : Melaleuca is a genus of nearly 300 species of plants in the myrtle family, Myrtaceae, commonly known as paperbarks, honey-myrtles or tea-trees. Melaleuca alternifolia is one of the more popular ones that are used medicinally. It looks like this one ton top, with rosemary like leaves, but it is white. They range in size from small shrubs that rarely grow to more than 1 m (3 ft) high, to trees up to 35 m (100 ft). Their flowers generally occur in groups, forming a “head” or “spike” resembling a brush used for cleaning bottles, containing up to 80 individual flowers. Image is from public domain

Holistic Treatment

1. Rigorous Eye Hygiene and  Warm Compresses

One of the goals in treating blepharitis is to soothe the inflamed eyelid and remove the crust that has built up on the eyelid and eyelashes. Using a warm compress can help to loosen the crust and it brings blood flow to the eyelid, which helps to speed healing.

In this perspective, one needs to use a clean washcloth and wet it with clean filtered warm water. Thenceforth,  wring it out and place it over the affected eye for 15 to 20 minutes. Three times daily to encourage drainage, reduce inflammation and speed up the healing process. If that alone doesn’t remove the dry flakes, use a clean cotton pad with water and a gentle organic shampoo to massage the area and moisten the flakes. Then, once the eyelashes are dry, carefully use a cotton swab to remove the flakes. Repeat daily until the crust or flakes stop developing. (Source)

2. Try Black Tea compresses

Applying a warm black teabag on the infected eye can serve as a natural blepharitis treatment because black tea, a fermented product, has anti-inflammatory and antibacterial activities. Research suggests that black tea has phenolic compounds and tannins that have the ability to inhibit the growth of bacteria. (Source)

To do this, place the black teabag in boiling water so that it begins to steep. Then wait for it to cool down, squeeze it to remove the water and place it on your closed eyelid. Let the teabag rest over the inflamed eyelid for about 10 minutes and then dispose.

3. Tea Tree Oil

Melaleuca alternifolia, commonly known as Tea tree has been employed as a holistic medicinal treatment plant for centuries. As an essential oil, Tea tree oil has strong anti-inflammatory, antibacterial and antimicrobial effects. (11). Multiple sources confirm that this mild essential oil is safe to use topically. (12)  Tea tree can also  soothe dry, flaking skin and remove dandruff. (Source)A 2012 study found that eyelid scrubbing with tea tree oil for one month significantly reduced the demodex mite count in patients with blepharitis. (Source) Treatment with tea tree oil kills Demodex mites as well as the surrounding deleterious bacteria thanks to which ocular symptoms are improved. (8) (Source)

“With both antimicrobial and anti-inflammatory effects, tea tree oil has been effective at eradicating mites, said Dr. Tseng, in either 50 percent lid scrubs or 5 percent lid massages”. (Source)

When applied directly to the skin, tea tree can be allergic and irritating for some people, so it is recommended to first test it on one’s arm skin.  Thereafter, one should dilute it with a carrier oil, like castor, olive or  coconut oil. Add 2–3 drops of tea tree and a half teaspoon of one of these carrier oils to a clean cotton pad. Apply it to the area of concern.

As expected, the American Cancer Society,  publically denies tea tree’s skin problems  infections medical value: “…despite years of use, available clinical evidence does not support the effectiveness of tea tree oil for treating skin problems and infections in humans.” (13)

For the H.M. Institute, Tea Tree is one of the best holistic techniques to use for this eye disorder because it is both effective and, with minimum precaution, safe, contrarily to essential oils like oregano, also an anti-microbial, but too strong and risky to spread on the eyelids.

“Eradication of Demodex infestation is accomplished using daily lid scrubs with tea tree oil (TTO). 50% TTO was initially used as the therapeutic dosing and was shown to reduce symptoms and inflammation of the cornea, conjunctiva, and lid margin”. (14)

4. Avoid Eye Makeup and Contact Lenses

Using eye makeup and contact lenses makes eyelid hygiene more difficult and can delay the healing process. Until blepharitis is treated, one should stop wearing eye makeup and use  eyeglasses instead of contact lenses. Preventively, it’s also a good idea to avoid all make-up personal care items that are placed on the eye area, unless they are organic and of high quality.

5. Treat Dandruff

Dandruff on the scalp causes redness and flaking that can spread and cause greasy scaling on the eyebrows, face and even the side of your nose. To get rid of dandruff that causes blepharitis, one can use natural remedies like coconut oil, essential oils, probiotics and omega-3 fatty acids. (Source)

Using organic shampoos that have bactericide essential oils like tea tree and rosemary essential oils are recommended since dandruff can fall in the eyelid area and cause blepharitis.

6. Anti-Inflammatory Foods

Sticking to a diet made up of anti-inflammatory foods will help to improve blepharitis symptoms naturally by reducing systemic inflammation and treating conditions that are associated with blepharitis, like rosacea. Some of the  best foods for healing blepharitis include: Omega-3 rich foods like wild-caught small fish (for the non vegans), or purslane, chia seeds, flaxseeds and walnuts for the vegans. These essential fatty acids helps to reduce inflammation and boost the immune system so that it can holistically target bacteria and mites. Research shows that consuming omega-3s helps to increase the fatty acid saturation content in the meibum glands. This helps to improve dry eye symptoms that can lead to blepharitis. (Source)

Organic fruits and vegetables: Fruits and vegetables contain anti-inflammatory compounds and antioxidants. They also help to boost the immune system and rebuild healthy skin cells by providing important eye vitamins like beta carotene, vitamins  C and E, lutein and other molecules. Bleuberries are especially indicated for any eye disorder. To which we can add healthy fats  that can be found in  avocado, nuts, seeds, coconut oil and olive oil, all of which reduce systemic inflammation and help to heal the skin.

7. Minimize Screens and-or Use the Blinking Technique and Filters

Blinking can decrease with age and when we are engaged in near-vision tasks, like using  computer and phone. Blinking helps the meibomian glands to secrete oil, which is important in order to avoid a blockage or abnormality that leads to dry eye and blepharitis symptoms. For those with posterior blepharitis, concentrate on blinking at least 20 times, four times a day to increase the secretion of oil that keeps your eyes lubricated. (Source).  When involved with an abundance of screening hours each day, it’s indicated to wear blue wave filtering glasses, especially at night.

Prevention measures

To prevent the spread of bacteria and eyelash mites that can cause blepharitis, eye hygiene is a must, which means to keep one’s eyelids clean and free from chemicals, irritants, allergens and deleterious microbes that can lead to eyelid inflammation. Below, a few proposed measures.

1. Gently wash eyelids with a mild, natural organic if possible soap with clean filtered warm water. Water can also be contaminated with deleterious bacteria and when there’s chlorine in the water, that can destroy the skin’s good bacteria that control the bad bacteria.

2. On occasion use warm compresses on eyelids in order to unclog the oil producing  meibomian glands.

3. Avoid rubbing the eyes, especially if hands aren’t clean. If applying eye makeup or contact lenses, make sure to wash hands first and that the makeup quality is organic and clean. Never use old make-up, could be infested with mites and deleterious bacteria.

4. Use natural organic moisturizers and organic cosmetic products that are free from chemicals and less irritating to the skin.

5.  Treat scalp dandruff immediately, before it spreads to eyes and face.

6. Clean and store contact lenses properly to avoid bacteria  build up.

7. Avoid potential allergens and inflammatory foods such as gluten, shellfish, dairy, meat, wheat, sugar, soda beverage and the like.

8. Avoid looking directly at the Sun and-or use filtering sunglasses during intense sunny days. Uv radiation produces free radicals which can damage the eyes, leading to glaucoma and other eye disorders and even blindness. While some light is needed, if only to activate cortisol and other hormones, direct bright sun light should be avoided.

9. Blinking consciously 20 times 4 times a day. (Source) Meibomian glands secrete oil by nerve action and the mechanical action of blinking.  But the rate of blinking decreases with age, a non holistic lifestyle and near vision tasks such as computer use.

10. Because these Demodex mites feed on the eyebrows and eyelids’ oil producing glands, (see picture above) it’s a good idea to clean the eyebrows and eyelids with diluted tea tree essential oil on a regular basis. (16)  There is a new product called cliradex that is made with the active ingredient that is contained in tea tree oil,  isolates 4-Terpineo. But this product is pricy and it’s still  a recent product, so we can’t be sure about its side effects (Source) (16)  And tea tree oils works. We just need to be cautious in the dosing.

11. Getting tea tree and rosemary essential oil massages after a hot sauna on a regular basis can also be a good way to reduce if not eliminate these mites. But this has to be done for three weeks straight in order to reach the mite’s larvaes. Using tea tree shampoo on hair and eye lashes every day for three weeks will also help.

12. As we saw above, these mites hate light. So we can go out in the sun so as to make their niche less hospitable. Recently, an intense pulsed light (IPL) therapy was engineered and used by dermatologists for treating rosacea and mite related diseases.  (17)

Thus, to prevent or treat blepharitis and many other skin and eye disorders, these above-mentioned hygiene measures should be practiced as much as possible. 

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Collarettes around the base of the lashes is a sign this blepharitis is caused by Demodex mites. Without remedial action, these eyelashes will get thinned and fall off.

Discussion

A direct consequence of Demodex proliferation is the dramatic increase in bacterial load on the eyelids, particularly B. olerinus. The excessive presence of B. olerinus near the eyelids triggers a cascade of events that often degenerate into chronic inflammation of the ocular surface. First, the immune system responds by orchestrating an army of proinflammatory agents, including antimicrobial peptides, toll-like receptors, cytokines, chemokines, and matrix metal-loproteinases (MMPs) (Source)  In small quantities, these agents may perform well. But an acute inflammatory response may turn into a chronic, self-perpetuating condition.

Second, B. olerinus releases toxic substances, including lipases which enzymatically alter lipid composition. A change in the ratio of saturated to unsaturated fats of the meibum  raises its melting point, increases its viscosity, and impede its secretion. In addition, one by-product of lipase activity on sebum/meibum is oleic acid, which  appears to  play a role in the keratinization of the lid margin, and plugging of the meibomian gland orifices.(Source) When meibomian glands  become clogged,  there is a change in meibum composition from  long-chain fatty acids to free fatty acids. FFAs, combined with inflammation, causes saponification that favors more the mites proliferation than homeostasis.

By heating the eyelid margin with a warm compress, these fats are transformed, from solid at room temperature, to a liquid, which gets secretions flowing again.

By applying a correctly dosed tea tree-carrier oil mixture across the infected area, these mites dont colonize as much and actually start to migrate out the follicles. They can then be removed by lid scrubs. (14)  

From the holistic perspective, it’s often amazing how skin and eye disorders like blepharitis will resolve just with heat, blinking exercises, reduction of chronic stress, some high quality pure essential oils and a good anti-inflammatory diet. This disease still can be challenging. But when we focus more on the root causes than symptoms, a durable resolution of the problem is favored.

Conclusion

For Conventional medicine, progress in elucidating the etiology of this condition, as demonstrated by the work of Dadaci et al (4) and others is being made. With greater mainstream research in this area and greater acceptance of the diagnostic criteria set up by international workshops, more drug target specific and long-term treatments for patients with blepharitis will emerge. (15) With conventional medicine, treatment of blepharitis is nonetheless still long and unsatisfactory.

On the other hand, for holistic medicine, simple and natural measures have existed for centuries, most of which can safely and efficiently treat most eye disorders.

With  proper hygiene and choosing the right skin care products for one’s skin type and leading a holistic lifestyle with an anti-inflammatory diet will maximize one’s chances to enjoy one’s eyes, the windows of thy Soul, as they were designed, without diseases and for over 120 years.

Christian Joubert (HMI director and CSO)

 Reference and Precision Notes

(1) Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O’Brien T et al. The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunctionInvest Ophthalmol Vis Sci 2011; 52: 2050–2064. (Source)
(2). Nichols KK. The international workshop on meibomian gland dysfunction: introductionInvest Ophthalmol Vis Sci 2011; 52: 1917–1921.  (Source)
(3). Knop E, Knop N, Millar T, Obata H, Sullivan DA. The international workshop on meibomian gland dysfunction: report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian glandInvest Ophthalmol Vis Sci 2011; 52: 1938–1978. (Source)
(4). Dadaci Z, Kılınç F, Ozer TT, Sahin GO, Acir NO, Borazan M. Periodic acid–Schiff staining demonstrates fungi in chronic anterior blepharitisEye (Lond) 2015; 29: 1522–1527. (Source)
(5).Nelson ME, Midgley G, Blatchford NR. Ketoconazole in the treatment of blepharitisEye 1990; 4(Pt 1): 151–159.  (Source)
(6). Dougherty JM, McCulley JP. Comparative bacteriology of chronic blepharitisBr J Ophthalmol1984; 68: 524–528. (Source)
(7). Kheirkhah A, Casas V, Li W, Raju VK, Tseng SC. Corneal manifestations of ocular Demodex infestationAm J Ophthalmol 2007; 143: 743–749.71.  (Source)
(8). Koo H, Kim TH, Kim KW, Wee SW, Chun YS, Kim JC. Ocular surface discomfort and Demodex: effect of tea tree oil eyelid scrub in Demodex blepharitisJ Korean Med Sci 2012; 27: 1574–1579.   (Source)
(9). Gao YY, Di Pascuale MA, Elizondo A, Tseng SC. Clinical treatment of ocular demodecosis by lid scrub with tea tree oilCornea 2007; 26: 136–143.  (Source)
(10). Dougherty JM, McCulley JP. Bacterial lipases and chronic blepharitisInvest Ophthalmol Vis Sci1986; 27: 486–491.  (Source)
(11). Carson, C. F.; Hammer, K. A.; Riley, T. V. (17 January 2006). “Melaleuca alternifolia (Tea Tree) Oil: a Review of Antimicrobial and Other Medicinal Properties”Clinical Microbiology Reviews19 (1): 50–62.
(12).  O’Brien, Peter; Dougherty, Tony (2007). The effectiveness and safety of Australian Tea Tree oil (PDF). Barton, A.C.T.: RIRDC. pp. 9–12. 
(13). Russell J, Rovere A, eds. (2009). “Tea Tree Oil”. American Cancer Society Complete Guide to Complementary and Alternative Cancer Therapies (2nd ed.).
(14). Gao Y, Di Pascuale M, Elizondo A, Tseng S. Clinical treatment of ocular demodecosis by lid scrub with tea tree oil. Cornea. 2007;26: 136-143. See also Gao YY, Di Pascuale MA, Li W, et al. In vitro and in vivo killing of ocular Demodex by tea tree oil. Br J Ophthalmol 2005;89(11): 1468-73.  Koo H, Kim TH, Kim KW et al. Ocular surface discomfort and Demodex: effect of tea tree oil eyelid scrub in Demodex blepharitis. K J Med Sci 2012;27:1574-9.Tighe S, Gao YY, Tseng SCG. Terpinen-4-ol is the most active ingredient of tea tree oil to kill demodex mites. Translational Vis Sci Tech 2013;2: 1-8.
(15). With research supported by the National Eye Institute, pharmaceutical industry has identified am active ingredient,  isolates 4-Terpineo, in tea tree oil for killing mites, synthesized it into a new lid scrub regimen, known as Cliradex.  https://cliradex.com/cliradex/ The key ingredient in Cliradex is simply water and 4-Terpineol, a natural organic compound found Melaleuca alternifolia. The other ingredients in Cliradex are in less than 1% of the patented formulation and are Glycerin, Polysorbate 20, Polysorbate 80, Carbomer, Triethanolamine. (Source)
(16). Eyelid cleaning procedure: First, clean eyelids with warm towel and then leave a warm compress on eyelids for 2-5 minutes in order to soften the eyelid’s lipid producing ducts.  Put one drop of tea tree in a cup and 3 drops of a carrier oil. An Alternative, one can put 1 drop of Tea Tree Oil on a very wet warm towel.  Dip a towel into the diluted mixture, close the eyes and Rub the corner of the eyelashes with YOUR EYES CLOSED to test to see if this Tea Tree Oil is not too strong. Dilute the towel (or cuetip with water more, if there is too much burning).  Scrub the closed eyelashes like  brushing  teeth.  Leave on for about 1 minute or let air dry if there is minimal burning. Wash off after a minute or so if still burning. If too strong, dilute the Tea Tree Oil to more than 50% initially and gradually build up the strength to about 50% dilution for best effectFurthermore,  because these mites are transferred between hosts through contact with hair, eyebrows, and the sebaceous glands of the face, it’s also a good idea to have regular hot saunas and tea tree and rosemary washes and massages thanks to which these mites and the eggs they lay in our hair follicles can get neutralized.
(17). The pigmented exoskeleton of Demodex contains chromophore that appears to absorb IPL  (Intense pulsed light) energy. Histologic analysis demonstrated that IPL treatment induces coagulation and necrosis of Demodex. By eradication of Demodex, IPL could decrease the microbial load on eyelids and potentially break the vicious cycle of inflammation. (Source)

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Disclaimer: Nothing in this educational blog should be construed as medical advise. If you notice any blepharitis signs or symptoms, you can speak to your doctor about trying a holistic  blepharitis treatment before turning to antibiotics or corticosteroids.
2017 (c). Happiness Medicine Institute and agents. All rights reserved.
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