One of the types of Dry Eye Disease (DED) is Evaporative DED which occurs as a result of evaporation of pre-corneal tear film. The corneal surface is constantly lubricated by a thin tear film which has three components.
The most superficial layer is the ‘oil layer’ which prevents the tear from evaporation. This oil/ lipid is secreted from the glands located inside the lids called Meibomian Glands. Whenever these glands under secrete/abnormally secrete the oil, the tear film loses its protective layer – and thus causing dryness/ discomfort of the eyes, called as Meibomian Gland Dysfunction (MGD).

We usually prescribe topical antibiotics, lubricants +/- oral antibiotics. But there is another criminal organism who hides in the hair follicles – Demodex which slowly releases toxins causing inflammation and aggravating the dryness caused by MGD. So here in AEH Coimbatore, whenever we diagnose MGD in individual patients, we epilate/ remove the lashes. Any we try to identify the Demodex parasite clinging on the hair lash follicle.

But why this is important?
Because identifying this parasite modifies our treatment.
The westerners use ‘tea tree oil’ – very prevalent cosmetic ingredient. But due to the cost of this medicine, we advise our patients to mix equal proportions of neem oil and coconut oil, ask them to apply on the eyebrows, facial hair and eyelashes and wait for about half an hour and then wash with neem soap. We get brilliant results from this traditional treatment! The key message is – to look for Demodex in MGD.
But, if identifying the Demodex on microscopy in MGD is an innovative practice, we wanted to amplify our care by taking it ONE step further. Because epilation isn’t painless – we need to remove four lashes, and we need a microscope to identify the parasite. So without epilation, by gently everting the upper lid of the pts with MGD and focusing on the hair follicles, we could locate the abnormally enlarged base of the follicle. Right there, we could find the tail of the Demodex.


To sum up, what we endorse here is not a product but a process – essentially it is a process innovation. We believe in these four steps.
Suspect Demodex in MGD pts
Look for tails on lash follicles on SL
Confirm Demodex on microscope
Enhance the Rx with neem oil and coconut oil.

Idea Generator – Aravind-Coimbatore Team