Q: I realize everyone rubs their eyes at times, like waking up in the morning, but I think I’m rubbing mine too much. I guess they itch a little, or I would leave them alone. My eyes are kind of gritty and dry at times also. What may be causing this?
A: I almost hate to tell you about the most likely cause, but here we go…. very commonly, during our routine eye health examination we find evidence of “demodex” in the eyelids. Most people have never heard of Demodex, but they are very common and tiny mites, think of “dust mites”, that like to live deep in the base of our eyelashes. Just as dust mites are ubiquitous, living in our pillows and mattresses, these little guys are virtually everywhere too.
These tiny mites live at the base of our eyelash follicles, literally inside our eyelids. We rarely see them on our patient’s eyelids, even though our biomicroscope gives up to 40x magnified view of the tissue. What we actually discover is the residue the mites leave on the base of the lashes. This biological residue irritates the delicate skin along the edges of our lids, causing low-grade itching. Technically, we generally see vascular inflammation along the lid edges as well…. making the eyelid margins look a little pink or red for some patients. And some patients can even see the debris on their eyelashes with the magnification of their makeup mirror.
Good news….finally….these are curable. For years we have used a natural remedy, dilute tea tree oil, to treat demodex. It works pretty well, but applying it along your eyelid edges is tedious and it burns. We now have a new ophthalmic medication called “xdemvy” which is more effective and more comfortable to use. You will need to see your eye doctor for an accurate diagnosis, and for the actual prescription, but this is fairly straightforward and very effective.
Most patients have immediate relief from itching/rubbing, and most tell me their eyes feel better in general. The secondary symptom of dry eyes, or grittiness, is generally relieved as well once the demodex infestation is solved. A word of caution….do not use regular tea tree oil in or near your eyes. Full strength, it can damage or “burn” the delicate tissues of your eyelids, and would certainly damage your eye surface.
Some studies found that most people do have some degree of demodex infestation, and we do see it very commonly in our practice as well. Lastly, I suppose most people have tried some over-the-counter eyedrops before they come to see us. Usually, no harm is done, but those drops at the pharmacy are not effective and just waste your money in dealing with demodex. Dry eyes can have many causes, and the best treatment can be specifically chosen for you based on your in-office exam and often lab results from tiny samples of your tears.