Treatment of ocular itching associated with ocular demodicosis by 5% tea tree oil ointment.

PURPOSE: To determine whether ocular itching associated with ocular demodicosis can be treated by lid massage with 5% tea tree oil ointment (TTOO).

METHODS: Twenty-four patients with ocular itching and ocular Demodex were treated with chlortetracycline hydrochloride eye ointment lid massage for 4 weeks and then treatment was switched to TTOO for another 4 weeks. They were examined every 2 weeks and their itching was graded as 0 (none), 1 (mild), 2 (moderate), or 3 (severe). Changes of itching scores and Demodex counts were compared.

RESULTS: Before the treatment, all 24 patients reported itching graded as 1 (n = 3), 2 (n = 15), and 3 (n = 6) for a period of 2 weeks to 2 years despite previous topical antibiotics, antiinflammatory medications, or antiallergy medications. Demodex counts per 8 epilated lashes were 5.5 ± 1.6 for all patients but 4.6 ± 1.5, 4.8 ± 1.9, and 7.1 ± 2.1 for patients with grade 1, grade 2, and grade 3 itchiness, respectively (P < 0.05 between grade 2 and grade 3). After 4 weeks of chlortetracycline hydrochloride eye ointment treatment, little changes were observed regarding itching and Demodex counts in all patients (P > 0.05). In contrast, after 5% TTOO treatment, 16 patients were totally free of itching and the remaining 8 patients had different degrees of relief (P < 0.01). The Demodex count decreased to 0.7 ± 0.8 for total (P < 0.01).

CONCLUSIONS: There is a strong correlation between ocular itching and Demodex infestation and between symptomatic resolution and reduction of Demodex counts by daily lid massage with 5% TTOO.