EYE AREA CARE
Tea tree oil for Demodex blepharitis
Penny Hatzis – Down Under Enterprises, Australia Phil Prather – Down Under Enterprises, US
The eyes are the window to the soul they say. Humans have had a fascination with beautifying the eyes dating back to Ancient Egyptian times, where kohl eyeliner was used to accentuate the eyes to emulate the appearance of the gods. This fascination continues today, with beauty procedures that enhance the shape of the eye such as mascara, eyelash extensions and eyelash perming being common practice. Our eyes provide sight, arguably at the top
of the ‘senses hierarchy’. They are a precious sensorial gateway that allows for light perception, colour vision and depth perception, shaping the way we experience the world. With so much importance placed on our eyes’ proper function, it is obvious that eye health and hygiene is of paramount importance. A commonly experienced eye condition that
presents as swollen, itchy, dry, and irritated eyes is blepharitis. For most people, blepharitis causes only minor irritation and itching, however, it can lead to more severe symptoms such as blurring of vision, photophobia,1
missing or misdirected
eyelashes, and inflammation of other eye tissue, particularly the cornea if left undertreated.2
What is Demodex? In stark contrast to the beautifying procedures undertaken for the eyes, a rather unsightly microscopic mite called Demodex can inhabit the eyelids and hair follicles of the eye lashes. Two distinct Demodex species have been
indicated as a cause of blepharitis: Demodex folliculorum can cause anterior blepharitis associated with disorders of eyelashes, and D. brevis can cause posterior blepharitis with meibomian gland dysfunction and keratoconjunctivitis.3 Most people have D. folliculorum on their
skin. Usually the mites do not cause any harm and are therefore considered an example of commensalism rather than parasitism. When the balance tips towards an overpopulation of Demodex spp., they can overwhelm the host immune response. A condition known as Demodicosis can develop. The Demodex mite can cause blepharitis by carrying bacteria on its surface including Streptococci and Staphylococci. With the presentation of Ocular Demodicosis, Demodex Blepharitis can ensue. Demodex mites may be also be a potential cause of recurrent and refractory chalazia (cysts in the eyelid).4 Traditional treatments have included warm compresses and antibiotic/steroid
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combinations. However, these therapies do not eradicate Demodex, often causing the condition to persist. Demodex mites are resistant to a wide range of antiseptic agents including 75% alcohol, 10% povidone-iodine, and erythromycin.5 A natural and very effective remedy has
been identified, using tea tree oil (TTO) for the eradication of Demodex infestation.
What is tea tree oil? Tea tree essential oil is steam distilled from the native Australian tree Melaleuca alternifolia. Historically tea tree oil has been used for its antiseptic and anti-inflammatory properties. TTO is composed of terpene hydrocarbons, mainly monoterpenes, sesquiterpenes and their associated alcohols. The composition of oil sold as TTO is regulated by the international standard for “Oil of Melaleuca—terpinen-4- ol type,” (ISO4730: 2017) which sets maxima and/or minima for 15 components of the oil, 7 physical parameters, and also identifies a natural chiral (enantiomeric) ratio to enable easy identification of adulteration.6 Tea tree oil has become a standard
ingredient in the treatment of Demodex Blepharitis, from retail eye make-up remover products to OTC and prescription-based optometry products.
What is the proof? Initial in vitro and in vivo research by Gao et al. (2005) found that TTO could eliminate Demodex with a 50% TTO and Shampoo Eyelash scrub.7
Demodex and improving subjective ocular symptoms. The procedure was conducted as follows:
■ 1 drop of 0.5% proparacaine (anaesthetic) was applied ■ A cotton tip wetted with 50% TTO was used to scrub the lid margin and lash roots three times with a 10-min interval between each scrub ■ Patients were instructed to continue scrubbing daily at home and advised to close their eyes and massage their lids with medium pressure for three to five minutes using a cotton tip wetted in 10% TTO ■ After the treatment, the skin was rinsed with clean water and dried with a towel ■ Patients were advised to perform home lid scrubs twice daily ■ Control group patients were treated with eyelid scrubs without TTO ■ Control group patients were asked to scrub their eyelid and lashes with only saline After eyelid scrub treatment, Demodex count
was reduced from 4.0 ± 2.5 to 3.2 ± 2.3 in the TTO group (p = 0.004) and from 4.3 ± 2.7 to 4.2 ± 2.5 in the control group (p = 0.27). Gao et al. later investigated the use of 5%
The researchers subsequently
introduced an eyelid scrubbing procedure utilising their findings. Koo et al. (2012) replicated this procedure in
their study, reporting that the TTO eyelid scrub treatment is effective for eliminating ocular
TTO Ointment for the alleviation of ocular itching associated with ocular demodicosis. Patients who had treatment with chlortetracycline hydrochloride eye ointment for 4 weeks had little change in itching and Demodex counts (p > 0.05). Patients treated with 5% TTO Ointment (n =16) were totally free of itching and the remaining 8 patients had different degrees of relief (p < 0.01). The Demodex count decreased to 0.7 ± 0.8 for total (p < 0.01). Karakurt et al. (2018) investigated
the efficacy of 7.5% TTO eyelash shampoo on the density of Demodex and ocular symptoms in patients with demodectic blepharitis. They reported that full demodex reduction was achieved in 36% of patients who used the eyelash shampoo with TTO and the average demodex count was reduced from 6.33/eyelash to zero (p < 0.001).8 A recently published study (Ergun, 2020)
reported that tea tree oil at a 3% concentration effectively improved ocular surface parameters including Demodex count.9
This is a much lower The Demodex mite.
concentration than reported in previous studies. The double-blind randomised clinical trial separated the patients with chronic Blepharitis into two groups. Group 1 was administered with a basic gel containing 3% (w/w) TTO and Group 2 (advanced gel containing 3% (w/w) TTO plus essential oils and vitamins. In both groups,
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