Demodex and Meibomian Gland Dysfunction

Meibomian Gland Dysfunction (MGD) is a major factor in Dry Eye Disease (DED), with upwards of 86% of DED sufferers showing evidence of MGD.[1] This chronic condition of the meibomian glands occurs due to gland obstruction and/or when there is a lack in the quality or quantity of meibum – the lipid component of the tear film – produced.[2] This alters the composition of the normal tear film which irritates the eye and often results in the patient experiencing signs and symptoms associated with DED. A variety of factors can affect the development of MGD including age, ethnicity, certain medications, contact lens wear, lid biofilm, and many more.

To enhance a tear film that may be lacking due to MGD, daily use of a preservative-free artificial tear is essential. I-MED Pharma’s I-DROP® MGD is the only premium visco-adaptive artificial tear targeted specifically for MGD. Containing both a superior quality hyaluronic acid as well as a lipid component to supplement the natural tear film, I-DROP® MGD is a preservative-free eye drop that provides superb coating and hydration to the ocular surface.

While there are many risk factors that can contribute to the development of MGD, Demodex is one that may require an in-clinic treatment by an eye care professional if it gets out of control. More on this later. The signs and symptoms of Demodex include itching, burning, irritation, blurriness, and swollen inflamed eyelids among many others that can lead to MGD. But first, what is Demodex and how is it associated with MGD? 

Demodex are eight-legged mites that live in the eyelids and eyelash follicles. All normal, healthy eyes have some Demodex colonizing the lids and lashes, but these mites can quickly become a problem if their numbers increase to the point of infestation. In addition to causing ocular issues including meibomian gland blockages, which alter the tear film, these mites introduce bacteria which leads to ocular inflammation. Demodex is also associated with various other skin and eye conditions such as rosacea and blepharitis. Tea tree oil in the correct concentration is found to be very effective in preventing the reproduction of Demodex found on eyelids and eyelashes. If a Demodex infestation is diagnosed, eye care professionals can guide the patient towards the correct treatment.

A manual in-clinic treatment known as blepharon-exfoliation or periciliary eyelid scaling is also available for the eradication of severe manifestations of Demodex. This consists of a rotating, moistened micro-sponge under a local anesthetic that descales and cleans the eyelid and lashes surface.  The 10-minute procedure is painless.

I-MED Pharma’s I-LID ’N LASH® PLUS is a water-based hyaluronic acid cleanser that contains 5% tea tree oil, a compound that has antibacterial, antifungal, and anti-inflammatory properties. Used daily, it will help interfere with the reproduction of Demodex and help manage an infestation. A daily ocular hygiene routine that includes I-LID ’N LASH® PLUS is an easy way to remove ocular debris with minimal irritation as well as enhance the effectiveness of artificial tears such as I-DROP® MGD.

Once the condition is under control, hypochlorous acid (HOCL) can be used as a daily spray to keep the lids clear of unwanted microbial growth. or a complete ocular hygiene routine. It can be used daily and in combination with I-LID ’N LASH® wipes or pump to maintain optimal lid and lash health. This all-natural, non-toxic spray-and-go product contains 0.02% HOCl to clean and hydrate the lids and lashes.

For any management plan to work effectively, daily treatment compliance is the key to experiencing long-lasting comfort as MGD is considered a chronic disease.

With the right management tools, patients can experience everyday relief from MGD, Demodex, and DED. Book your dry eye consultation or comprehensive eye exam today at or call our clinic at 905-828-2282.

[1] Lemp, M. , Crews, L. , Bron, A. , Foulks, G. & Sullivan, B.  (2012). “Distribution of Aqueous-Deficient and Evaporative Dry Eye in a Clinic-Based Patient Cohort.” Cornea 31 (5): 472-478.  doi: 10.1097/ICO.0b013e318225415a.

[2] Nelson, J Daniel, Jun Shimazaki, Jose M Benitez-del-Castillo, Jennifer P Craig, James P McCulley, Seika Den, and Gary N Foulks. 2011. “The International Workshop on Meibomian Gland Dysfunction: Report of the Definition and Classification Subcommittee.” Investigative Ophthalmology & Visual Science 52 (4): 1930–37.