Tom Busby, poster extraordinair at RF, posted the following which is worth reading (post no 2 in this thread):  Hi Stephan, you're right that demodex can cause dry eye symptoms, and plugging of the meibomian glands. Your photo shows a small whitish plug inside the margins of the eyelashes, which is where the meibomian glands are located. I suggest you read as much as you can, and use google search terms like "inspissated meibomian glands," which is the medical term for plugged meibomian glands, and your description of dry eyes upon waking is called "saponification." "Meibomian Gland Dysfunction" (MGD) is the general term, and demodicosis or demodectic blepharitis would be more specific terms.

The medical profession is obsessed with the naming of things, and you'll eventually learn more if you go through the steep learning curve of learning the medical terms. I did all this when I found I had conditions very similar to yours.

Plus, the eyes have extremely complicated anatomy, which you will need to learn. To get you started, the function of the meibomian glands is to release a tiny bit of oil each time you blink (from the blink pressure) and the oil floats on top of the tear film, and slows down the evaporation of the aqueous component. The Glands of Moll and the Glands of Zeiss also release oil. The lack of oil is the problem, and is why eye drops don't do anything at all.

The plug that is outside the margin of the eyelashes, in your photo, is most like a plugged up Gland of Moll. These plugs are mostly a cosmetic problem, and are the result of dead demodex decaying and causing an allergic reaction. A prominent rosacea MD refers to them as "the gravestone of a dead demodex." The crusty skin below your eyes appears to be a combination of demodex-induced and malassezia-induced reactions. Climbazole treats against malassezia, but does nothing against demodex.

You can gently express the meibomian glands, and you'll learn a lot by examining the quality and quantity of fluid that comes out. You'll need to read a lot more about this, but in very general terms, it's easier to start with the lower lid, and roll a finger gently up. Don't do this over and over, because the amount of oil in the mebomian glands is tiny, and there's no point to emptying the glands by doing it over and over. Most likely, nothing will come out of your meibomian glands, which is not what you want to see, at all, but it will show how bad the situation is. Perhaps the fluid will be discolored, or thickened -- this is also showing the need for treatment.

The best current medically accepted treatment is 25% Tea Tree Oil (TTO), or preferably, a derivative of it called terpinen 4-ol. These procedures and products are patented. The main problem is that these treatments can't be self-administered, because both products burn the cornea, and generally require about a weekly one-hour office visit to an ophthalmologist. Worse yet, in the US these treatments aren't covered by insurance, but I'd like to know if they are covered in Canada. Treatments would cost tens of thousands of dollars. The condition, if it is indeed and allergic reaction, is most likely recurring.  

You could self-treat with Cliradex wipes, which are 5% TTO, or terpinen 4-ol, but the concept could also be imitated by making your own Cliradex wipes, with 5% TTO and 95% MCT oil. Use before bedtime. Demodex males move around at night, and they're easier to kill. TTO is a contact-killer.

I never used TTO or terpinen 4-ol as a treatment, because the idea of putting any essential oil near my eyes seemed to being inviting a disaster. My eyes are too important to me, as I read a lot.  

However, after two years of effectively treating against seb derm induced by an allergic reaction to malassezia, using climbazole as the active ingredient, I found that my eyes were becoming more dry and bloodshot, so a year and a half ago, I went through a second incredibly steep learning curve to find out how I could treat MGD and demodectic blepharitis. 

As I had previously learned how to make an MCT lotion and an MCT shampoo/shower gel with climbazole, I decided to test other compounds -- only safe ones -- and I found that piroctone olamine suppressed or eradicated demodex. Now my meibomian glands are unblocked, and have remained unblocked for over a year.  

I use piroctone olamine at a concentration of 0.14%, and climbazole at 0.09%. Neither of these products is applied directly to the cornea or onto an open eye, which would be ridiculously dangerous in my opinion.

However, my method of trying something to see if it works, is generally called "foraging research" and is not considered scientifically acceptable today, but it's how most discoveries were made before medicine became so incredibly complex and expensive. Nevertheless, I was so exhausted by the expense and futility of the medical system, that I did my own research and experimentation both as to malassezia and then as to demodex.

Expect to use daily treatment with topical piroctone olamine for 23 days to see initial results, and 120 days for about 99% treatment, and 180 days for full treatment. The process of taking a shower, lathering up with the shower off for 3-5 minutes, then rinsing off and towel drying, and then applying a lotion, is very simple, so the time involved is not oppressive because the treatment is merely ordinary, daily hygiene, using an effective ingredient.

There's a larger list of things that either don't work, or don't treat against demodex, and they're listed here, and in many other medical articles:  http://www.reviewofophthalmology.com/content/c/36944/ 

You can't buy piroctone olamine-based cosmetics in the US or Canada because there isn't a Final Monograph approved by the FDA, and Canada follows the FDA in these matters. However, there is a Preliminary Monograph on Octopirox, another name for piroctone olamine, and one can see that piroctone olamine has a 3000 to 1 safety ratio, which is huge. With climbazole, the EU considers a 100 to 1 safety margin acceptable, so it's clear that piroctone olamine is much safer.

There is no reason for a manufacturer to spend the millions of dollars necessary for a Final Monograph on piroctone olamine, because there are many OTC products overseas and already on the market, making the expense unrecoverable. The same reasoning shows the futility of a patented prescription product, although it would be possible, but it would be undercut by consumers who are willing to buy OTC products from overseas web-vendors.

You could find some of these OTC piroctone olamine products on eBay or Amazon, but I'm not certain if they would ship them to the US or Canada. It would be worth your time and effort to try to obtain these products, as they aren't very expensive.

Keep in mind that I'm merely a guy that reads a lot and is willing to try to figure things out, so you'll need to form your own conclusions. Good Luck!

In a recent interview, Sai Pallavi clarified that it is not acne and it’s an atypical disease she is suffering with. ‘It is Rosacea. I am photo sensitive. Whenever I am exposed to camera and light, my face turns pink,’ the actress said. Fidaa Girl Sai Pallavi suffers with skin disease – Rosacea, Celebs Cinema
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Related Articles Etiologies and management of cutaneous flushing: Nonmalignant causes. J Am Acad Dermatol. 2017 Sep;77(3):391-402 Authors: Sadeghian A, Rouhana H, Oswald-Stumpf B, Boh E Abstract
The flushing phenomenon may represent a physiologic or a pathologic reaction. Although flushing is usually benign, it is prudent that the physician remains aware of potentially life-threatening conditions associated with cutaneous flushing. A thorough investigation should be performed if the flushing is atypical or not clearly associated with a benign underlying process. The diagnosis often relies on a pertinent history, review of systems, physical examination, and various laboratory and imaging modalities, all of which are discussed in the 2 articles in this continuing medical education series. This article reviews flushing associated with fever, hyperthermia, emotions, menopause, medications, alcohol, food, hypersensitivity reactions, rosacea, hyperthyroidism, dumping syndrome, superior vena cava syndrome, and neurologic etiologies.
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Demodex Solutions, one of our sponsors, is experimenting with a new improved ZZ like cream that hopefully will help with dry skin and is seeking six (6) willing volunteers who will provide before and after photos for this trial and details of your experience. You will receive free trial samples shipped to your address at no charge to you for shipping or the samples. However, you must provide before and after photos to be selected for this trial.  If you are interested, you must follow these steps:  (1) Join the RRDi and be sure to confirm by clicking on the validation email sent to you so you are a registered member.  (2) After logging to your RRDi account, use the contact form and request an application which will be sent to you after you join the RRDi in step one.  In the contact form request to be part of the Demodex Solutions trial that you want the samples mailed to you. Remember, only six will be chosen so please follow the directions we send you. If you have dry skin that would be a plus for your being selected. Demodex Solutions will choose from among the applicants the final six trial members. You may live anywhere in the world since the samples will be mailed to your address at no cost to you. 

Related Articles Electrosurgery for the Treatment of Moderate or Severe Rhinophyma. Actas Dermosifiliogr. 2017 Aug 09;: Authors: González LF, Herrera H, Motta A Abstract
Rhinophyma, a rare and progressive disfiguring condition, is thought to be the final stage of rosacea. Several surgical treatments are available, including dermabrasion, cryosurgery, scalpel excision, electrosurgery, and carbon dioxide laser. The last 2 techniques are the most effective for the management of rhinophyma. We describe a series of cases of moderate or severe rhinophyma treated with high-frequency electrosurgery in the dermatology department of Hospital Simón Bolivar and in private clinics in Bogota, Colombia, between 2012 and 2016. The cosmetic result, as assessed by both the clinicians and the patients, was satisfactory in all cases. Three patients presented hypertrophic scars that were treated with steroid injections and silicone gel sheeting. Two patients presented persistent erythema. However, there were no serious infections and none of the patients required further surgery. Electrosurgery is one of the simplest and most cost-effective techniques currently available for the treatment of rhinophyma by dermatologists.
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