Do I Have Demodex? A Self-Assessment

Key overview

  • Collarettes — cylindrical cuffs wrapped around the base of a lash — are the one feature specific enough to carry real weight on its own.
  • Almost everything else on the list is shared with other causes of blepharitis, so single symptoms score little.
  • Demodex is near-universal in adults. The question is never presence but whether the population is large enough to be causing your symptoms.
  • This is a triage tool, not a diagnosis. Confirmation is a lash epilated and examined under a microscope, which takes minutes in a consulting room.

Mite-driven blepharitis is treated differently from the bacterial and seborrhoeic forms, so the question is worth answering rather than guessing at. This page is a structured way of weighing what you can observe yourself. It will tell you whether Demodex is a reasonable explanation for your symptoms. It cannot tell you that you have it.

How to use this

Score each item honestly, add the total, and read the band at the end. You will need a magnifying mirror and good light, ideally in the morning before washing your face. Look at the base of the lashes, not the lashes generally — the diagnostic detail sits in the first millimetre or two above the lid margin.

Strong indicators — 3 points each

  • Clear cylindrical sleeves or cuffs wrapped around the lash shaft at its base, which move with the lash rather than flaking off. These are collarettes, and they are the closest thing to a specific sign; cylindrical dandruff explained shows what distinguishes them from ordinary scale.
  • Blepharitis that has returned repeatedly despite thorough, sustained lid cleaning.
  • A diagnosis of rosacea, particularly with facial flushing or papules, alongside lid symptoms. The rosacea association is well recognised.

Supporting features — 2 points each

  • Itching at the lid margin that is distinctly worse on waking and eases through the morning.
  • Lashes that are brittle, misdirected, sparse or falling out in one area.
  • Lid margins that look thickened, irregular or persistently red at the edge.
  • Recurrent styes or chalazions in the absence of another explanation.

Non-specific — 1 point each

  • Gritty, burning or foreign-body sensation
  • Crusting or lids stuck together on waking
  • Watering eyes
  • Contact lens wear that has become progressively less comfortable
  • Age over fifty, since mite prevalence rises steadily with age

Reading your score

Total Interpretation
0-3 Demodex is an unlikely explanation. Your symptoms are more consistent with MGD or another form of blepharitis.
4-7 Possible but unconfirmed. Worth raising at your next eye examination rather than treating speculatively.
8 or more, or any collarettes Demodex is a plausible or likely contributor. Worth confirming, and reasonable to start conservative lid hygiene in the meantime.

Two cautions about the bands. Collarettes on their own carry more weight than a high score built from non-specific items, because grittiness, crusting and watering are produced by every cause of lid disease. And a low score does not exclude mites; it means they are not the most likely explanation for what you are experiencing.

What an optometrist adds

Under a slit lamp, at magnification you cannot reproduce at home, collarettes are obvious and their density can be graded. If confirmation is needed, a lash is epilated and examined under a microscope, where the mites are visible directly and can be counted. That is the definitive test, it takes minutes, and it is the difference between treating a mite problem and treating a guess.

An examination will also settle the things this checklist cannot: whether the meibomian glands are involved, whether the margin is inflamed for another reason, and whether anything on your lid needs attention in its own right. Lash loss confined to one spot, an ulcerated or bleeding lid lesion, or a lump recurring in the same place should always be examined rather than scored.

If the answer comes back positive, how to get rid of Demodex mites and the twelve-week protocol are the next things to read. Background on the organism itself is in what eyelash mites are and the fuller Demodex blepharitis guide.

Part of our guide to Demodex & Blepharitis.