Tea Tree Oil Eyelid Wipes Versus Periocular Shampoo in Demodex-Associated Chronic Blepharitis: A Retrospective Study

Background: Demodex-associated blepharitis is a chronic inflammatory eyelid disease characterized by collarettes, eyelid margin inflammation, and the presence of Demodex mites. Comparative data on different tea tree oil (TTO)-based application forms remain limited. This study compared the clinical and microscopic outcomes of TTO-based eyelid wipes and eyelid shampoo in Demodex-positive chronic blepharitis.Methods: In this retrospective, single-center study, 155 adults with clinically and microscopically confirmed Demodex-positive chronic blepharitis were grouped by treatment form: eyelid wipes (n=74) or eyelid shampoo (n=81). Baseline and 3-month assessments included subjective symptoms, Ocular Surface Disease Index (OSDI) scores, collarette severity, eyelid margin erythema, meibum quality, meibomian gland obstruction, and microscopic Demodex status.Results: Baseline demographic and clinical characteristics were similar between groups. At 3 months, symptoms improved in both groups, but burning was less frequent in the wipe group (p=0.048). The OSDI score was lower in the wipe group (24.4±7.5 vs 27.3±8.6; p=0.026). Collarette and meibum quality scores favored the wipe group (p=0.011 and p=0.003, respectively). Meibomian gland obstruction scores were comparable (p=0.87), whereas improvement in eyelid margin erythema (89.2% vs 76.5%; p=0.038) and meibomian gland obstruction (83.8% vs 67.9%; p=0.022) was more frequent in the wipe group. Demodex eradication rates were similar (64.9% vs 60.4%; p=0.570).Conclusion: Both TTO-based formulations were associated with clinical improvement and comparable Demodex eradication. Eyelid wipes may provide additional benefit for ocular surface-related quality of life and selected eyelid margin and meibomian gland outcomes. Prospective randomized studies are needed to confirm these results.