CLINICAL

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RELIEF FROM DEMODEX

TEA TREE OIL SOLUTIONS CAN BE OFFERED FOR THESE STUBBORN MITES

JEFFRY D. GERSON, O.D., F.A.A.O.

I GREW up being told, “don’t let the bed bugs bite,” as my parents tucked me in. As it turns out, we should be thinking the same thing when we see patients who we think have “typical” blepharitis. Could it be something more insidious?

Demodex is a microscopic parasite found on the skin and some hairs. It is found increasingly in patients age 60 and older, according to a study in Journal of American Optometric Association. The tell-tale sign is cylindrical dandruff at the eyelash base.

Once Demodex is identified, what do we do about it?

EDUCATE THE PATIENT

One effective treatment for Demodex seems to be tea tree oil, which has a toxic effect on the mites. Before recommending tea tree oil, it is important to inform patients why previous treatments have not been successful and how this option may provide some relief for their condition:

“I understand that Demodex can be a very frustrating condition and it has persisted for some time. It generally does not respond favorably to our mainstay treatments, such as warm compresses, antibiotics or steroids. But now that we have identified the specific cause for your discomfort, this treatment, some of which will take place in the office, some at home, has a good chance of providing you some relief.”

PROVIDE OPTIONS

In-office treatment is a possibility. There are commercially prepared options for use by the eye care provider, such as concentrated tea tree oil products applied to lashes and brows. The cost to the provider is relatively small, the time required is fairly short, and relief to patients can sometimes be instant.

These in-office treatments are billed as an out-of-pocket expense to the patient. Charges can vary; price it at whatever you deem is appropriate for your practice. Often, these treatments will not be the end-all, be-all. They are the start of treatment, or the first step in “putting out the fire.”

PRESCRIBE OPTIONS

Many patients will then require at-home treatment. (It becomes a chronic treatment for the chronic problem.) This at-home therapy is the maintenance for “keeping the fire out,” and keeping inflammation from Demodex at bay.

In-home treatment involves a tea tree oil-based solution that can be either in wipe or foam form. It is applied to the eyelids and eyelashes. These at-home treatment options can be sold in the eye care provider’s office, or patients can be guided to company portals that sell these products. Either way, these products provide the potential for both better patient health and economic health of the practice. Even though the practice may only profit a few dollars, to up to around $10 per month, for at-home patient therapy, this adds up quickly, especially if you consider how many patients to whom this is applicable.

PROVIDE RELIEF

Patients who are treated successfully for Demodex may become some of your happiest patients. After numerous attempts at treatments and different diagnoses, they finally are better. And like so many other things, when you provide good medicine, more patients will follow.

So, the next time you have a patient with “stubborn” blepharitis, consider Demodex and the possibilities that it presents! OM

DR. GERSON practices at Grin Eyecare in Olathe, Kan., a full-scope combined O.D./M.D. practice. He has nothing to disclose. Email him at jgerson@hotmail.com, or visit tinyurl.com/OMcomment to comment.