How to Treat Blepharitis Eyelid Irritation

Blepharitis, inflamed eyelids, can be annoying as well as painful. It is frequently quite difficult to treat. The usual recommendation is to use hot compresses on the affected eyelid. If that does not work, eye doctors now have a powerful new medication to prescribe.

Can Xdemvy Ease Blepharitis?

Q. My eyelid was irritated when I saw my ophthalmologist last year. He said I had eyelid mites and had me use Noveha, a tea tree oil-based eyelid cleanser. In addition, I used neo/poly B/dexamet ointment for two weeks. After two weeks, he prescribed Xdemvy and recommended I continue use of the eyelid cleanser.

My eyes were constantly filmy and sensitive to light for the first two weeks. I stopped the Xdemvy after four days as my eyes began to ache and burn. Can you shed some light on this condition for me?

A. Eyelid mites are also known as Demodex. That’s the genus name. They live in the follicles of the eyelashes and are too small to see without magnification. Some people seem to react strongly to them by developing inflammation. In fact, dermatologists suspect that Demodex may also contribute to inflammation of the facial skin, called rosacea.

Lotilaner (Xdemvy) is a compound that paralyzes and kills the mites. A review of six randomized clinical trials concluded that this medicine “offers a novel, effective therapy for this condition, enabling earlier intervention and improved outcomes for patients” (HCA Healthcare Journal of Medicine, June 1, 2025).  In clinical trials, about 10 percent of people experienced stinging and burning when they applied Xdemvy drops.

This drug is expensive. According to Drugs.com, Xdemvy solution could cost almost $2,000 for 10 ml. That’s about two teaspoons of medicine, which should last six weeks. Some insurance companies cover this treatment, while others may not.

If blepharitis is severe, the prescription approach may make sense. On the other hand, one reader found a simple remedy that works well.

Treating Blepharitis with Dandruff Shampoo:

Q. I have had awesome results with T/Gel for my rosacea and blepharitis. My blepharitis was so bad that my eyelid had cracked open. After one treatment it cleared up. I was amazed that my skin also felt softer and the redness faded.

A. Blepharitis means inflammation of the eyelid. When this is caused by yeast overgrowth on the skin, dandruff shampoo can often be helpful.

T/Gel, a coal-tar-based dandruff shampoo, discourages the Malassezia yeast that is associated with seborrheic dermatitis, dandruff and blepharitis. Like any shampoo, T/Gel can sting the eyes, so take care when using it on the eyelids.

You are not the only one who has found T/Gel helpful for blepharitis.

Patty offered her experience:

“I bought T/Gel and starting washing the whole eye area with it, and after two days the rash started to subside. It’s been about four days now, and it’s getting a little better every day.

“The T/Gel definitely hurts if it gets in my eyes.

“I don’t know for sure whether it’s the T/Gel itself which is working or just scrubbing really well. Once my rash is completely gone, I’m going to switch to baby shampoo. I understand now why using baby shampoo is recommended; if scrubbing is all that is needed, baby shampoo makes it possible to do that without it being so unpleasant that you’re tempted to give it up. Something I also wanted to share with others here is: I think what we’re hearing about ‘good hygiene’ is confusing. The thing is: a lot more than normal good hygiene is required with this. We’re trying to remove microscopic stuff from tiny folds of skin, in a really sensitive place, and it takes a lot of effort and time. But it’s working.

“I’ll do it for the rest of my life if I have to, as long as it works! That’s why I think it will be important to switch to baby shampoo. That pine-tar-oil stuff in T/Gel may be really effective, but hopefully isn’t necessary to maintain a blepharitis-free face.

“Also: after I do the scrubbing, my face feels super tight and dry and uncomfortable, and that’s where the soothing stuff comes in. I have three favorites, all from Whole Foods or a similar store: (1) jojoba oil, (2) a comfrey salve, and (3) a lotion with calendula. They’re all a little different, and I alternate between them.”

Dandruff Shampoo Against Rosacea:

Rosacea is also an inflammatory response to yeast, bacteria or mites. People with rosacea suffer with red, sensitive skin that breaks out in bumps. This inflammation sometimes spreads to the eyes, making them red and irritated, and to the nose, which can become misshapen like W. C. Fields’s nose.

There are medications to treat rosacea, but many other readers agree that washing the face with dandruff shampoo can ease redness due to rosacea. Here are a few examples:

Readers’ Testimonials:

Clare wrote:

“I started using Selsun Blue over one year ago, and I have had no flare ups. Exactly the same as when I bought $100+ bottles of prescription sulfacetamide lotion. I don’t need to pay for a doctors visit every year to have her pronounce that I still have rosacea.”

KVS added:

“I have also been using the dandruff shampoo for my rosacea. It does work great and costs pennies! Prescription drugs from a dermatologist did nothing. I stopped using them and one day put a little dandruff shampoo on my face when I was washing my hair – what a nice surprise and so easy!”