The Effectiveness of Lid Cleansers in Eradicating Demodex

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Demodex blepharitis: White arrows denote cylindrical dandruff at the base of the lashes, while the black arrows show live Demodex mites under 100X magnificationKabat A. 1


Demodex associated blepharitis is extremely prevalent, particularly among older individuals. While virtually all of us have some Demodex mites, symptoms may start to appear when the population reaches a critical mass and there are more organisms living in the tissue. Many patients will present with non-specific ocular irritation including burning of the eyes, itchy eyelids, redness, swelling, and debris on their lashes.

These symptoms tend to be more pronounced in the evening and overnight due to the activity of Demodex, as they are nocturnal. Additionally, studies indicate that patients with certain forms of rosacea have a higher incidence of Demodex. It’s important to make an accurate diagnosis and begin an effective treatment that gets to the root of the problem versus just treating symptoms.

Over the past few years, I’ve seen implications that hypochlorous acid solution (e.g. Avenova) has the ability to eradicate Demodex. However, in studying the literature I’ve never found any evidence of a conclusive, prospective study to assert this claim. Intuitively, it didn’t seem right that an antimicrobial – which is primarily efficacious against bacteria and viruses – would work on a multicellular organism like Demodex. So, again, I searched and couldn’t find a thing. I also talked with several colleagues who, like me, couldn’t understand how such a claim could be true.

I decided to test this hypothesis by comparing commercially available lid cleansers for their ability to kill Demodex in vitro; specifically, I designed a study to compare hypochlorous acid solution (Avenova) with 4-Terpineol, found only in Cliradex. I also looked at mineral oil as a control agent.  

The Study

The study was set up as follows:

  1. Identify patients with Demodex;

  2. Take samples of live Demodex still on lash follicles;

  3. Plate them onto slides and put in the solution of choice running three at a time;

  4. Monitor over the course of 90 minutes, checking every 10 minutes to see if they were still moving and alive.

Upon concluding the study, I found that the mineral oil had no effect, as anticipated – all of the organisms tested over the 90 minutes survived and remained viable. With Avenova, there was minimal effect, with 79% of the organisms surviving through the 90-minute mark. However, Cliradex was very effective, consistently killing 100% of Demodex mites by the 40-minute mark. Comparing the average kill time, there was a statistically significant difference in favor of Cliradex as compared to Avenova. And when we compared Avenova to the mineral oil, there was no statistically significant difference. The conclusion is that Avenova is simply not an effective demodicidal agent, whereas Cliradex clearly has that ability.

What sets Cliradex apart is its key ingredient 4-Terpineol, the most important organic component of tea tree oil (TTO). TTO is the essential oil derived from the native plant Melaleuca alternifolia, which is characterized by 13 major components. Scientific studies have shown that 4-Terpineol, or Terpinen-4-ol (T4O), is the most important ingredient found in TTO, with even greater miticidal effects than TTO itself2. This is because some of TTO’s ingredients are ineffective and their relationship is antagonistic. Cliradex works when treating Demodex and is also a natural, preservative-free way to cleanse the eyelids and lashes. As we all know, Demodex blepharitis is a unique condition, and you must first identify whether that is the underlying cause of symptoms, and then treat it with a product that has proven efficacy.

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  1. Kabat A.  In vitro demodicidal activity of commercial lid hygiene products. Poster #905 - B0083. The Association for Research in Vision and Ophthalmology (ARVO) 2018. 
  2. Sean Tighe, Ying-Ying Gao, and Scheffer C. G. Tseng, Terpinen-4-ol is the Most Active Ingredient of Tea Tree Oil to Kill Demodex Mites, Translational Vision Science & Technology Journal, 2013, 2.7.2

Dr. Al Kabat, is a professor at Southern College of Optometry in Memphis, Tennessee. In addition to teaching, he serves as a staff doctor in the Adult Primary Care and Advanced Care Ocular Disease Services at The Eye Center. Dr. Kabat has published extensively in the optometric literature, and serves in an editorial capacity for Review of Optometry, Optometric Physician and Optometric Office.