In case you haven’t noticed, tea tree oil (TTO) has recently been the subject of much attention throughout the ophthalmic community.
It is being targeted as a treatment option for various types of surface disease, including Demodex blepharitis.
Tea tree oil has been used for countless conditions in past and present including:
- Acne
- Fungal Infections
- Lice
- Athlete’s Foot
- Ringworm
- Insect Bites
- Scabies
In addition to its application in various pathologies, tea tree oil also being used quite successfully as a makeup remover and ingredient in face wash and shampoo.
Tea tree oil (TTO) contains nearly 100 separate components, which may account for its numerous conventional uses.
Medicinal properties include:1
- Anti-inflammatory
- Mild to moderate acne vulgaris
- Regulation of wheal
- Antiprotozoal / Acaricidal
- Sarcoptes scabiei “scabies”
- Demodex
- Pediculus humanus capitis “head lice”
- Antibacterial
- MRSA
- S. Aureus
- Coagulase-negative staphylococcus
- Antifungal
- Tinea pedis “athlete’s foot”
- Onychomycosis “fungal nail infection”
- Candida
- Seborrheic dermatitis
- Antioxidant
- Anti-tumor
- Antiviral
- Hand warts caused by HPV
- Other
- Dandruff
- Wound healing
- Chronic gingivitis and bad breath
Do not confuse tea tree oil with the common beverage. TTO is oil distilled from the Australian native plant Melalecua alternifolia.
How tea tree oil works:
The largest component found in TTO is terpinen-4-ol (minimum of 30%),1 which has strong antimicrobial and anti-inflammatory properties. The second largest ingredient is 1,8-cineole.
The proposed mechanism of action includes decreasing the production of tumor necrosis factor (TNF), IL-1, IL-8, IL-10, and prostaglandin E2, all of which are involved in the inflammatory response. TTO does not suppress the production and activation of neutrophils. Inhibition of acetylcholinesterase is the hypothesized mechanism of TTO’s antiprotozoal properties.2
Tea Tree as an anti-inflammatory agent for the skin:
If you ask, many of your patients may be using tea tree oil as a face wash, particularly those patients who prefer a more natural or holistic daily cleanser. Some patients may even be using tea tree oil as a remedy for acne.
Studies are split on the effectiveness for the treatment of acne vulgaris.
A single-blind, random controlled trial in 124 patients used 5% TTO gel for the treatment of mild to moderate acne and compared it to 5% benzoyl peroxide. The study concluded that both treatment methods were effective acne treatments in both inflammatory and noninflammatory acne lesions.1
The TTO treatment had slower treatment effects, but also had fewer side effects.
Adverse effects of TTO can include skin irritation, allergic contact dermatitis, systemic hypersensitivity reactions and stinging/burning upon application.
A double-blind study showed that benzoyl peroxide was significantly more effective in treating inflamed lesions, but that both treatments were efficacious at treating non-inflamed lesions.
A different double-blind, random controlled trial was performed on 60 patients with mild to moderate acne. A significant difference was observed between TTO and placebo treatment in both total acne lesion counts and on the acne severity index.3
Recommending patients talk to their dermatologist about TTO as a treatment for their acne is an easy way for optometry to collaborate with dermatology.
This can be especially beneficial to both healthcare professionals when co-managing dry eye disease patients on more intense acne therapies such as accutane. (Other ocular side effects of accutane include color vision loss, nyctalopia, SPK, Blepharoconjunctivitis, dryness, and lid edema).4
A small study of 27 volunteers showed that topical TTO was effective at reducing mean wheal (tissue oedema) volume compared to placebo (p= 0.0004).5
Volunteers were injected with histamine disphosphate (to simulate an insect bite or allergen exposure) followed by application of either liquid paraffin or TTO. There was a significant difference in wheal volume beginning at 30 minutes and continuing until the end of the study parameters (60 minutes) with TTO as compared to the control. There was not a significant difference in flare (erythema) area and itch score between TTO and the control.5
This study is one of many showing proven anti-inflammatory effects from treatment with TTO.
Tea Tree Oil for the eyes:
As optometrists, the ocular adnexa is included in our scope of practice. This includes the delicate skin around the eyes as well as the eyelids and eyelashes.
Tea tree oil has many optometric indications for the use on ocular adnexa. One of the most widespread uses of TTO include demodex infestations. “A retrospective review of clinical studies demonstrated that an eyelid scrub with TTO can effectively eradicate eyelid demodex and improve demodiciosis.” 1
Eye Eco has a gentle Tea Tree Eyelid & Facial Cleanser™ containing either 1% TTO in their gentle formula or 2% TTO in their advanced formula. Both include Vitamin-E, which is a strong anti-oxidant, shea butter, which is a skin moisturizer, and chamomile, which is postulated to help with skin irritation, eczema, and psoriasis.
Eye Eco’s eyelid and facial TTO products offer an alternative to Cliradex® lid scrubs which can be overwhelming at times. For the more cosmetically minded patients, Eye Eco offers a tea tree scrub that includes the clinically proven anti-aging component Regu-Age®.
There is no shortage of shampoo brands containing tee trea oil. TTO shampoos offer soothing aromas as well as fighting power against dandruff and head lice. “A 1% tea tree oil solution was found to kill 100% of head lice (Pediculus humanus capitis) within 30 minutes, in vitro.” 2
Do note that in vitro results cannot always be mimicked clinically; however, there is modest clinical support for the use of TTO shampoo against head lice. TTO shampoo also acts as a repellant and can be used preventatively.
“Tea tree oil repelled 55% of the lice from the treated area, which was superior to other interventions, such as peppermint oil (34%) and N,N-diethyl-3-methylbenzamide (DEET) (26%). Similarly, tea tree oil also prevented 60% of the lice from feeding on the treated skin.”2 TTO shampoo is not as effective as a suffocative formulation containing benzyl alcohol and mineral oil against unhatched lice eggs: 44.4% and 68.3%, respectively.2
Tea Tree Oil as an antibacterial agent:
Studies have shown that washing the skin with 5% TTO is effective in removing MRSA from the skin.1 However, other studies have shown conflicting results.
TTO should be considered as an adjunctive treatment for MRSA in most cases due to insufficient clinical evidence. Conversely, TTO is a clinically effective antibacterial agent against S. Aureus, the most common culprit of blepharitis.
Using EyeEco’s Tea Tree Eyelid & Facial Cleanser™ on the eyelids and eyelashes can be an effective treatment for blepharitis.
Blepharitis is known to cause irritation and itch and can complicate dry eye treatment and or ocular surgeries. Lid hygiene should be stressed before cataract surgery to ensure excellent outcomes and minimize risk for complications after surgery.
Tee Tree Oil as an antifungal agent:
Different concentrations of TTO are available and have different uses. For example, 100% TTO applied to nails twice daily can improve the appearance and symptoms of toenail fungus in over 50% of patients.1
Seborrheic dermatitis is characterized by flaky, scaly and crusty skin and can affect a large age demographic from infants to geriatrics. Postulated causes include a combination of factors: stress, genetics and naturally occurring yeast on the skin. Tea tree oil is effective against this yeast and can be applied topically to treat this condition.
Other uses of Tea Tree Oil:
Judicious use of TTO as a mouthwash can help reduce plaque and bad breath. It is also used to treat chronic gingivitis.
Tea tree oil is likely unsafe when ingested and should never be orally consumed.
Side effects of people who have ingested TTO included confusion, inability to walk, unsteadiness, rash and coma. No research has reported death caused by ingestion of TTO.6
My personal experience with tea tree oil:
I personally use Eye Eco’s Tea Tree Eyelid & Facial Cleanser™ every morning to clean my eyelashes and face. It leaves my skin feeling fresh and the minty tingle helps me wake up in the morning. I prefer the advanced formula containing 2% TTO. I also use an amazing tea tree shampoo by OGX®.
The benefits of tea tree oil are compelling and I find myself frequently writing down recommendations for Eye Eco’s Tea Tree Eyelid & Facial Cleanser™ for patients who are suffering from blepharitis, demdodex, rosacea, and facial dryness with or without acne breakouts and other skin conditions.
I have a patient I am currently treating for ocular surface disease who has dry, scaly skin and flaky dandruff in her eyelashes. She was on a lid regimen of Avenova BID and also had a BlephEx treatment, but is still having issues with blepharitis. I recently incorporated Eye Eco’s Tea Tree Eyelid & Facial Cleanser™ into treatment regimen and I am excited to see new results.
Tea tree oil has a cornucopia of practical uses in health care and optometry.
While prescription strength medications are essential and often indicated for the treatment of medical conditions, it is exciting to be able to have a non-prescription option to treat a plethora of patient conditions.
Perhaps the most exciting thing about the proven effects from TTO is the hope of discovering other naturally occurring medications derived from plants and animals on this amazing earth.
References:
- Pazyar, N., Yaghoobi, R., Bagherani, N. and Kazerouni, A. (2013), A review of applications of tea tree oil in dermatology. Int J Dermatol, 52: 784–790. doi:10.1111/j.1365-4632.2012.05654.x
- Gregory PJ. Tea Tree Oil for Head Lice. Medscape. http://www.medscape.com/viewarticle/857444. Published January 21, 2016. Accessed September 14, 2016.
- Bagherani, N. and Smoller, B. R. (2015), Role of tea tree oil in treatment of acne. Dermatologic Therapy, 28: 404. doi:10.1111/dth.12235
- Cheatham KM, Cheatham MA, Wood KB. KMK Education Services. Vol 2. 7th ed. KMK Educational Services, LLC; 2014. Pages: 496, 499.
- Koh, K.J., Pearce, A.L., Marshman, G., Finlay-Jones, J.J. and Hart, P.H. (2002), Tea tree oil reduces histamine-induced skin inflammation. British Journal of Dermatology, 147: 1212–1217. doi:10.1046/j.1365-2133.2002.05034.x
- TEA TREE OIL: Uses, Side Effects, Interactions and Warnings – WebMD. WebMD. http://www.webmd.com/vitamins-supplements/ingredientmono-113-tea tree oil.aspx?activeingredientid=113. Accessed September 13, 2016.
