Between 40-70% of all symptomatic eyes have a Demodex mite infestation. These 8-legged parasites are associated with chalazia, folliculitis, rosacea, and especially blepharitis. Current first line treatments for ocular demodicosis are topical and oral antiparasitics. Tea tree oil, Melaleuca alternifolia, has demonstrated antiparasitic, and antibacterial benefits in human and laboratory (vitro) studies. Tea tree oil eye-wash formulations have become more prevalent in the last 15 years, this article appraises the highest available quality clinical trials regarding tea tree oil and ocular Demodex infections. Two randomized control trials met inclusion criteria; they found significant improvement in mite count and symptom reduction with placebo-controlled interventions. Shortfalls included follow-up disparities, high fidelity treatment tolerance metrics, and other external validity issues; overall, the studies contained quality statistics, equal prognostic variables, study design and demonstrated powerful results with tea tree oil treatments.
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