If you’ve ever woken up with red, itchy eyelids and just blamed it on allergies or too much screen time, you’re not alone. But there’s a surprising and very common culprit that most people have never heard of: Demodex blepharitis, a condition caused by microscopic mites living on your eyelids. Ophthalmologists estimate that about 25 million people in the United States may have this condition roughly one in twelve. We spoke with Dr. Caroline Watson, an eye specialist, to shed light on this overlooked eye problem.
Demodex blepharitis is an inflammation of the eyelids caused by an overgrowth of Demodex mites, tiny parasites that naturally live in or near the hair follicles of the face including your eyelashes. “Most people find the idea of mites on their skin unsettling, but Demodex mites are very common and usually harmless,” explains Dr. Watson. “They aren’t a sign of bad hygiene, and they don’t discriminate by age or background. Most of the time, they coexist with us without causing any problems. But if their population gets out of control, that’s when symptoms start to show up.”
The most common signs of Demodex blepharitis are red, itchy eyelids, irritated eyes, and sometimes even missing or misdirected eyelashes. “Many patients complain of chronic itching, redness, and a gritty sensation, especially after reading or using screens for long periods,” says Dr. Watson. “Since these symptoms can be confused with allergies or dry eye, the condition often goes undiagnosed or is mistaken for something else.”
There is, however, a telltale sign unique to Demodex blepharitis: collarettes. These are waxy, cylindrical crusts found at the base of the eyelashes, made up of mite waste and eggs. “If an eye doctor spots collarettes during an eye exam, it’s a clear indicator of Demodex blepharitis,” Dr. Watson notes. Using a slit lamp a special microscope with a bright light doctors check the eyelash line for this specific debris and other symptoms like irritation and inflammation to make the diagnosis.
For a long time, the only way to manage Demodex blepharitis was with eyelid hygiene regular cleaning, hot compresses, and careful removal of debris. But in July 2023, the FDA approved a breakthrough prescription treatment: XDEMVY® (lotilaner ophthalmic solution) 0.25%. This eye drop, used twice a day for six weeks, is the first and only FDA-approved medication that directly targets Demodex mites. In clinical trials, half of the patients who used XDEMVY saw a dramatic decrease in the number of collarettes, and about 60 percent experienced a complete eradication of the mites after 43 days of treatment. “It’s a game-changer for patients,” says Dr. Watson. Still, she warns that the drops can cause stinging and burning in about 10% of users, and other rare side effects may occur.
If you notice red, itchy eyelids or “crusties” at the base of your lashes, it’s time to see an eye doctor. An early diagnosis can help you start the right treatment and significantly improve your comfort and quality of life. “Proper management can make a big difference,” Dr. Watson emphasizes. And for those with contact lenses, remember to remove them before using XDEMVY and wait at least 15 minutes before putting them back in, as the medication can discolor soft lenses.
While the thought of eyelid mites might sound unpleasant, understanding Demodex blepharitis and knowing that there’s now a targeted treatment can bring relief to millions who have suffered in silence. Don’t ignore persistent eyelid discomfort help is finally here.
This article is intended for informational purposes only and should not replace professional medical advice. Always consult your healthcare provider with questions about your health.
