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Hidden bugs that live on our eyelids.

Mites in disguise


Have you ever wondered what else other than eyelashes are hanging about our eyelids? Well firstly let’s take a deep dive through the lenses of a slit lamp which your optometrist will use to assess your eyes. It is basically a microscope that magnifies the image of your eyes by up to 40 times. In this article my goal is to enlighten you about the types of bugs that are hidden away along your eyelids and may be picked up when you nest go to see your optometrist.

Well for most of us we all have natural bacteria that live on the surface of our skin, eyes and inside our body. These bacteria are needed to maintain good health and removal of unwanted waste products. The most common type of bacteria that may colonise on your eyelids would be a type of bacteria called Staphylococcus. There are others but this one is the most common cause of a type of condition called Blepharitis. This causes inflammation of the eyelids and also a range of other unwanted symptoms. The other common “creature” that your optometrist will find during your eye test will be Demodex blepharitis. This mite is commonly seen and the hallmark sign would be a cylindrical collarette on individual eyelashes. (OMG did you say mites?) Yes they are mites but not the kind that you may be thinking of. They are actually a type of parasite that coexist with us but sometimes multiply to an extent that causes quite a bit of irritation and itching.


Staphylococcus Aureus

This is the most common bacteria that infects the eyelids. They are sphere shaped and it is their exotoxins that are released that cause the inflammatory response as well as the crust that appears in the morning upon waking along the lashes.











Demodex is a parasite that lives on the skin and around the hair follicles, but for some people they will inhabit the follicles along the eyelids. Under an electron microscope these little critters look like something that came out of an alien movie. They look quite freaky.




What to expect?


For many of our patients that present for an eye examination they will have the one or more of the following symptoms:

Itchy eye
Irritating eye
Eye rubbing
Watery eye
Stinging eye
Swollen eyelid
Redness of the eyelids
Crusting found upon waking up in the morning
Loss of eyelashes
Missing eyelashes
Eyelashes that are misdirected
Red/Pink eye


As you can appreciate there are so many symptoms that can be associated with the bugs that live on your eyelids and it is so important to ensure you have a comprehensive check with you optometrist using slit lamp assessment on high magnification to determine the cause of the symptoms as this can also masquerade as other conditions.

You cannot hide 


Each day in the clinic your optometrist will see a patient that has some form of blepharitis. Up to 80% of patients will present with some signs of lid crust or flakes or deposits. However not all of the patients that present for eye care will have symptoms. It is not uncommon to see an elderly patient with severe demodex blepharitis yet they do not report any symptoms associated with the infestation. In these cases we would still recommend some form of treatment and usually a video and photo of the disease is sufficient for the patient to go home and perform the daily treatment regime.

Love them lashes


So you recently got eyelash extensions and they look great. Making you look glamorous. And then the therapist gives you advice on how to care for your new eyelashes. And one of them is to avoid water and soap to clean them. So during those few weeks you don’t clean your eyelashes well guess what? Yes you know they are filthy and there is a really high chance they will have some form of blepharitis. The little critters love the extra lash density and the crust will start to build up. But it is definitely totally up to you as we tend to put up with the pain and discomfort of the itchy and irritable eyes to gain the pleasure of looking and feeling beautiful.

The arsenal


Once your optometrist makes a diagnosis. She will then make some recommendations for treatment. The goal of treating this eye disease is to remove as much of the flakes and deposits as possible which will then lead to a reduction in the symptoms. We can do this using a range of products. The go to management in most cases will be eyelid hygiene and cleansing.

We can use a product called Blephadex which comes in a bottle or as lid wipes and this product is used to scrub along the lashes and base of the hair follicles on the upper and lower eyelid. Generally you will have to cleanse at least twice a day for the treatment to be effective. Other home made preparations are not as effective. In the past your eye care professional would recommend a diluted formulation of baby shampoo but recent studies by J Sung et al show that baby shampoo is not effective at reducing ocular surface inflammation compared to commercially available eyelid cleansers like Blephadex.

In severe cases of bacterial related blepharitis an antibiotic ointment may be prescribed which is applied four times a day. However lid scrubs are also recommended in conjunction.

Since blepharitis is a type of inflammation, your optometrist will sometimes start your treatment by prescribing a low dose corticosteroid which will really help.

In stubborn cases your optometrist can also book you in for an in office treatment using a device that literally spins and cleans the crust off the eyelids. Your optometrist will use a solution of concentrated tea tree oil to cleanse your eyelids. This treatment is very effective but requires and experienced optometrist to perform the procedure so that the solution does not get into your eyes. In most cases the in office treatment will need to be repeated a few times to ensure all the bugs are removed leaving you a nice clean set of lashes.

One thing for certain is you should avoid eye rubbing as this will increase your chances of infecting the oil glands along your eyelid which will lead to a bid sore red lump on your eyelid called a stye. These stye’s are an infection of the eyelid glands and can become very painful and in some cases can leave an unsightly lump within the eyelids that requires surgery to remove it.

Just make sure you always wash your hands thoroughly throughout the day and especially if you are thinking of touching your eyes.

These bugs just won’t go away


When you have been diagnosed with blepharitis you may want to stay away from use of makeup as well as contact lenses until things are under control. In our experience our optometrists tend to see patients that have thicker eyelashes or multiple rows of lashes develop bugs on the lashes more often. This could be because the thicker lashes make it harder to clean. Also the bacteria and mites tend to also come back. This means that you will have to consider ongoing treatment. Generally speaking if you have had signs of blepharitis you should make sure to be diligent with your eyelid hygiene. The good news is this condition does not cause loss of vision but the constant red and itchy eyes can be very annoying. On top of that this condition is treatable and with diligent cleansing you will be able to keep it under control.



Do not suffer from red, sore, and crusty eyelids any longer. Call Eyecare Network on 9728 7288 to make an appointment to see one of our highly experienced and friendly optometrist.

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