Ophthalmic Delusional Parasitosis

Ophthalmic delusional parasitosis is a mental health condition where a person has a fixed, unshakable belief that parasites (like insects, worms, or mites) are living in or around the eyes, even though medical exams show no real infestation. The feeling can be very real to the person. They may feel crawling, stinging, or biting around the eyelids or on the eye surface. They may see normal eye debris (like dried tears, skin flakes, or fibers) and believe it is proof of parasites. This belief does not go away when tests are normal or when doctors reassure the person.

Ophthalmic delusional parasitosis happens when someone develops a fixed, unshakeable belief that parasites are in their eyelids, lashes, tear film, or eyeball. The belief lasts for a month or more, does not fit with medical findings, and is not better explained by another mental illness like schizophrenia. This pattern fits the DSM-5/DSM-5-TR rules for delusional disorder, somatic type (the theme is the body). People may also feel “formication,” a crawling or biting feeling, or see tiny specks they believe are insects. These sensations are often tactile hallucinations that the brain misinterprets. The person’s day-to-day life can be stressed, but their speech and thinking may otherwise look normal. MedscapeNCBI

This is a somatic-type delusional disorder focused on the eyes. It often overlaps with eye surface irritation (like dry eye or blepharitis) and body sensations called formication (a crawling or tingling feeling). People commonly bring “samples” in a small box or bag (sometimes called the “matchbox sign”) to show the “parasites.” These samples usually contain skin flakes, eyelashes, lint, or crusts—not living organisms.

The key point: the symptoms feel real, but no parasites are found despite careful testing. The distress is genuine and can be severe. Good care is respectful, non-judgmental, and aims to reduce eye discomfort while also treating the delusional belief with mental-health support.

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How this happens

• Eye irritation starts the cycle. Dry eye, eyelid inflammation, allergies, or contact lens problems can cause itching, burning, or gritty feelings.

• The brain tries to explain the feeling. When the sensation is intense or long-lasting, the brain may misinterpret normal debris (like mucus threads or lash dandruff) as parasites.

• Attention increases the sensation. Constant checking with mirrors, tweezers, or phones, and rubbing or washing the eyes too much, can damage the skin and surface, making more irritation and more sensations.

• The belief becomes fixed. Anxiety, stress, poor sleep, isolation, or an underlying psychiatric or neurological condition can make the false explanation (“it must be parasites”) feel 100% true, even when tests are negative.

This loop keeps the condition alive unless both ocular irritation and the delusional belief are addressed with kindness and structured care.

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Types — simple classification

1. Primary ophthalmic delusional parasitosis (primary somatic delusion).
   The eye-focused parasite belief is the main problem. There is no other major mental or medical illness causing it.

2. Secondary (functional) ophthalmic delusional parasitosis.
   The belief appears as part of another psychiatric condition, such as major depression with psychotic features, schizophrenia spectrum disorders, bipolar disorder, or severe anxiety/obsessive–compulsive disorder.

3. Secondary (organic) ophthalmic delusional parasitosis.
   The belief is related to a medical or neurological problem (for example, dementia, Parkinson’s disease, vitamin B12 deficiency, thyroid disease, substance use, or medication side effects).

4. Shared (induced) delusional parasitosis (folie à deux).
   A close family member or partner adopts the same belief about eye parasites through shared stress, close contact, or persuasive influence.

5. Eye-surface-dominant vs. systemic-dominant forms.

   • Eye-surface-dominant: Focus is on lashes, lids, conjunctiva, tears; lots of rubbing, swabbing, plucking.

   • Systemic-dominant: The person believes parasites move from eyes to face, scalp, or whole body.

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Causes (or contributors)

These are possible drivers or triggers. In many people, more than one factor is present.

1. Primary somatic delusional disorder. A fixed false belief focused on the eyes without another medical cause.

2. Severe depression with psychotic features. Low mood with delusions can attach to bodily sensations, including the eyes.

3. Schizophrenia spectrum disorders. Psychosis can create strong, unshakeable false beliefs about parasites.

4. Bipolar disorder (mania or mixed states). High energy and racing thoughts can fuel intense body-focused beliefs.

5. Obsessive–compulsive disorder (OCD). Intrusive worries about contamination can become a parasite belief.

6. Substance use: stimulants (e.g., methamphetamine, cocaine), prescription stimulants misused. These drugs can cause formication (crawling sensations) and strengthen delusional ideas.

7. Alcohol withdrawal. Can cause tingling, itching, and misinterpretation of sensations.

8. Parkinson’s disease. Neurochemical changes and some Parkinson’s medications can lead to delusions and skin sensations.

9. Dementia (including Lewy body, Alzheimer’s). Changes in thinking and perception may cause misidentification of debris as parasites.

10. Thyroid disease (hypo- or hyperthyroidism). Can cause mood shifts, anxiety, dry eye, and abnormal sensations.

11. Vitamin B12 or folate deficiency. Can damage nerves and cause tingling, burning, and odd sensations.

12. Diabetes (neuropathy). Nerve damage causes tingling or crawling feelings around the face and eyes.

13. Liver or kidney failure. Toxin buildup causes itching and abnormal sensations.

14. Perimenopause/menopause or other hormonal shifts. Can worsen dry eye and skin sensations.

15. Prior real infestation (e.g., head lice, scabies) now resolved. A past true infestation can sensitize the person to normal debris.

16. Chronic insomnia or severe stress. Poor sleep amplifies itch and lowers reality-testing, making beliefs more rigid.

17. Traumatic brain injury or stroke. Brain changes can produce somatic delusions.

18. Medications (e.g., high-dose steroids, dopaminergic drugs, some antidepressants or anticholinergics). Side effects can include agitation, dryness, or psychosis.

19. Eye surface disease (dry eye, meibomian gland dysfunction). Gritty, burning sensations and mucus strands can be misread as worms.

20. Eyelid inflammation (blepharitis, Demodex eyelash mites) or allergies. Real irritation or lashes debris can be misinterpreted as an ongoing infestation despite treatment.

Important: Items 19–20 can cause real ocular findings (dryness, dandruff-like sleeves on lashes with Demodex, allergy swelling). In ophthalmic delusional parasitosis, the belief of persistent parasites remains despite appropriate treatment and negative targeted tests.

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Common symptoms

1. Fixed belief of “parasites in my eyes.” The person is certain, even after normal tests.

2. Crawling, biting, or stinging feeling on eyelids, lashes, or the eye surface (formication).

3. Severe itching of lids and surrounding skin.

4. Burning or gritty eyes (often from dry eye or over-cleaning).

5. Red, watery eyes from irritation and rubbing.

6. Stringy mucus or crusts that are seen as “worms” or “eggs.”

7. Frequent eye rubbing, scraping, or washing with harsh agents (which makes irritation worse).

8. Eyelash pulling or trimming to “remove parasites,” causing bald patches or lid injury.

9. Skin cuts, scabs, or chemical burns around the eyes from home “treatments.”

10. Blurred vision (from dry eye, abrasions, or ointment overuse).

11. Light sensitivity because the surface is inflamed.

12. Bringing “samples” (skin flakes, fibers, lashes) in boxes or bags as proof.

13. High anxiety and poor sleep due to constant monitoring and fear.

14. Doctor shopping and repeated urgent visits when tests are negative.

15. Social withdrawal or depression because the problem feels unsolved and embarrassing.

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Diagnostic tests

• Rule out real eye disease first. Doctors carefully examine the eyelids, lashes, conjunctiva, cornea, and tear film. If there is blepharitis, dry eye, allergy, or genuine Demodex, they treat it.

• Look for body-wide causes. They check thyroid, B12/folate, diabetes, liver, kidney, and medication lists. They also ask about substance use and sleep.

• Assess thinking and mood gently. They look for depression, anxiety, psychosis, OCD, dementia, or Parkinson’s disease.

• Communicate with empathy. They do not argue about the belief. They validate the distress, explain what tests show, and offer a plan to reduce symptoms and protect the eyes, while suggesting mental-health support as part of whole-person care.

A) Physical Exam

1. Comprehensive eye history and mental-status check.
   The clinician asks about symptoms, timing, triggers, sleep, stress, and belief strength. They note mood, anxiety, and thinking clarity.

2. External eye and skin inspection.
   They look for scratch marks, scabs, chemical irritation, or lash loss that suggest self-treatment injury.

3. Eyelid and eyelash examination at the slit lamp.
   The microscope checks for blepharitis, Demodex sleeves at lash roots, meibomian gland blockage, and crusts.

4. Conjunctiva and cornea evaluation.
   The doctor looks for redness, punctate spots, abrasions, or ulcers that explain discomfort.

5. General skin and scalp exam.
   They check for true lice or scabies elsewhere, eczema, psoriasis, or allergy signs that could mimic or trigger symptoms.

B) Manual (Office) Tests

6. Upper and lower lid eversion.
   The lids are flipped to look for trapped debris or foreign bodies that could cause scratching.

7. Eyelash epilation for light microscopy.
   A few lashes are gently removed and examined to confirm or exclude Demodex or other organisms.

8. Schirmer’s test (tear quantity).
   Small paper strips measure tear production to identify dry eye as a contributor.

9. Fluorescein corneal staining.
   A safe dye shows surface damage (tiny green dots) from dryness, rubbing, or chemicals.

10. Tear film breakup time (TBUT) and meibomian gland expression.
    Measures tear stability and checks oil gland function to guide dry-eye treatment.

C) Laboratory & Pathology Test

11. Complete blood count (CBC) with differential.
    Looks for eosinophilia (allergy/parasite patterns), anemia, or infection clues.

12. Thyroid function tests (TSH, free T4).
    Finds hypo- or hyperthyroidism that can cause dryness and mood/psych changes.

13. Vitamin B12 and folate levels.
    Detects deficiencies that cause neuropathy and abnormal sensations.

14. Fasting glucose or HbA1c.
    Screens for diabetes and nerve problems that cause tingling/crawling.

15. Liver and kidney function tests.
    Looks for systemic causes of itch and abnormal sensations.

16. Toxicology screen (as indicated).
    Checks for stimulants or other substances that can create formication and delusions.

Optional targeted tests (when indicated): skin scrapings from non-ocular itchy areas if true infestation is suspected; swabs for bacterial culture if there is infection.

D) Electrodiagnostic Tests

17. Electroencephalogram (EEG) (selected cases).
    If there are episodes suggesting seizures, EEG checks brain activity.

18. Visual evoked potentials (VEP) (selected cases).
    Used when visual pathway disease is suspected. It confirms the signal from the eye to the brain is working normally.

E) Imaging Tests

19. MRI of brain and orbits (when red flags are present).
    If there are neurological signs (new severe headache, vision loss, focal deficits, confusion), MRI checks for stroke, tumor, inflammation, or other causes.

20. In-vivo confocal microscopy or anterior-segment OCT (as available).
    High-resolution imaging of cornea/lashes/meibomian glands clarifies dry eye, scarring, or Demodex-related changes, and helps rule out unusual surface conditions.

Non-pharmacological treatments

Important: These approaches aim to relieve distress, protect the eyes, and build trust, so that effective medical care is accepted.

1. Therapeutic alliance (rapport-building).
   Purpose: Make care feel safe and respectful.
   Mechanism: A neutral stance (“we don’t see organisms right now; your symptoms are real and we’ll treat them”) reduces confrontation and improves follow-up. NCBI

2. Psychoeducation in plain language.
   Purpose: Explain how body sensations and worry can reinforce each other.
   Mechanism: Understanding the condition lowers fear and improves openness to treatment. NCBI

3. CBT for psychosis (CBT-p).
   Purpose: Loosen the grip of the belief; reduce checking/avoidance; improve sleep and coping.
   Mechanism: Works on cognitive biases, safety behaviors, and worry; meta-analyses show small-to-moderate symptom benefits. PMCOxford Academic

4. Family intervention/support.
   Purpose: Reduce arguments and “proof-seeking” cycles at home; address shared delusions when present.
   Mechanism: NICE recommends family work for psychosis; it reduces relapse and distress. NICE

5. Harm-reduction coaching for the eyes.
   Purpose: Stop injuries.
   Mechanism: Replace harsh cleaners with sterile saline or lubricating drops; avoid tweezers, sharp objects, and peroxide/alkali on lids. American Academy of Ophthalmology

6. Treat true ocular surface disease (if present).
   Purpose: Calm real irritation (dry eye/blepharitis) that can fuel the belief.
   Mechanism: AAO guidelines support warm compresses, lid hygiene, and preservative-free lubricants as first-line. American Academy of OphthalmologyAAO Journal

7. Structured sleep program (CBT-I basics).
   Purpose: Better sleep reduces suspiciousness and misperception.
   Mechanism: Regular sleep/wake times, wind-down routines; insomnia treatment is part of psychosis care packages. NICE

8. Stress-reduction training (breathing, brief mindfulness).
   Purpose: Lower physiological arousal that amplifies skin/eye sensations.
   Mechanism: Calms the “threat system,” which can otherwise intensify formication.

9. Substance use intervention (if relevant).
   Purpose: Stop stimulant-related tactile hallucinations and alcohol-withdrawal formication.
   Mechanism: Addiction treatment and relapse prevention reduce symptom triggers. NCBI

10. Environmental irritant control.
    Purpose: Avoid things that worsen ocular surface discomfort.
    Mechanism: Limit smoke, strong solvents, desiccating air; use humidifiers and frequent screen breaks (blink). AAO Journal

11. Nutrition basics.
    Purpose: Correct deficiencies (B12/folate/Vit D) that can aggravate psychosis-like symptoms if low.
    Mechanism: Lab-guided replacement only—avoid megadoses without indication. PMC+1

12. Regular ophthalmology follow-up.
    Purpose: Catch abrasions early and reinforce safer routines.
    Mechanism: Collaborative, scheduled reviews sustain behavior change. NCBI

13. Dermatology partnership.
    Purpose: Rule out skin infestations definitively and treat dermatitis from self-care attempts.
    Mechanism: Shared messaging prevents “doctor shopping.” NCBI

14. Primary-care and psychiatry coordination.
    Purpose: Address medical contributors and guide medications when ready.
    Mechanism: Team care improves adherence and outcomes. NCBI

15. Eye-safe cleansing routine.
    Purpose: Relieve crusting/irritation without damage.
    Mechanism: Warm compress 5–10 min, gentle lid wipes, preservative-free tears 4–6×/day as needed. American Academy of Ophthalmology

16. Demodex-focused lid care when truly present.
    Purpose: Reduce mite load if confirmed.
    Mechanism: Tea-tree–derived products at lower concentrations are less irritating; evidence remains uncertain, so use cautiously and under clinical guidance. PubMed

17. Safety plan for crises.
    Purpose: Rapid help if eye injury, infection, or suicidal thoughts occur.
    Mechanism: Clear emergency steps reduce risk and delay.

18. Activity scheduling & social support.
    Purpose: Shift focus away from constant checking; improve mood.
    Mechanism: Behavioral activation reduces rumination.

19. Peer support / lived-experience groups (psychosis services).
    Purpose: Normalize feelings; share coping tools.
    Mechanism: Promotes hope and practical strategies in line with NICE principles. NICE

20. Relapse prevention plan.
    Purpose: Recognize early warning signs (sleep loss, increased checking) and act early.
    Mechanism: Pre-agreed steps with the care team.

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Drug treatments

Good to know: Medicines work best when true infestations are excluded and the plan is framed around easing distress and sensations, not “treating schizophrenia.” Start low, go slow, and combine with the non-drug steps above. Typical doses below reflect what’s reported in reviews/case series for delusional infestation; always individualize with a clinician.

1. Risperidone (atypical antipsychotic).
   Dose: start 0.5–1 mg at night; typical 1–4 mg/day (some series up to 8 mg/day).
   When: once daily or divided; titrate weekly.
   Purpose/Mechanism: dopamine D2/serotonin 5-HT2 blockade; reduces delusional conviction and tactile misperceptions.
   Side effects: sleepiness, dizziness, weight/metabolic changes, elevated prolactin; possible QT effects. Oxford AcademicPMC

2. Olanzapine (atypical antipsychotic).
   Dose: start 2.5–5 mg at night; usual 5–10 mg/day.
   Purpose/Mechanism: D2/5-HT2 antagonism; calming effect on distress and itching.
   Side effects: weight gain, lipids/glucose changes, sedation. Evidence supports benefit and better tolerability than older agents. JAMA NetworkPMC

3. Aripiprazole (partial D2 agonist).
   Dose: start 5–10 mg/day; range 5–30 mg/day.
   Purpose/Mechanism: stabilizes dopamine signaling; often weight-friendlier.
   Side effects: akathisia/restlessness, insomnia, GI upset. Case reports and small series support use. Taylor & Francis OnlinePMC

4. Quetiapine (atypical antipsychotic).
   Dose: start 25–50 mg at night; titrate to 100–300 mg/day depending on response.
   Purpose/Mechanism: sedating, anxiolytic properties can help sleep and distress.
   Side effects: sedation, orthostasis, metabolic effects. (Listed among recommended SGAs.) NCBI

5. Pimozide (typical antipsychotic; no longer first-line).
   Dose: historically 0.5–3 mg/day; avoid unless specialist-supervised.
   Why caution: higher risk of QT prolongation and extrapyramidal symptoms; safer SGAs preferred. ECG monitoring needed if ever used. PMC

6. SSRIs (e.g., sertraline, escitalopram) for comorbid anxiety/depression or obsessive features.
   Dose: standard antidepressant doses; start low.
   Purpose: lowers anxiety/worry loops that keep checking/cleaning going.
   Side effects: GI upset, sleep changes, sexual side effects. (Adjunctive use reflected in DI practice reviews.) PMC

7. Mirtazapine (sedating antidepressant).
   Dose: 7.5–15 mg at night; may help sleep, appetite, and itching.
   Side effects: weight gain, daytime sedation. (Used pragmatically in psychosis-related insomnia/anxiety.) NICE

8. Short-term antihistamines (e.g., hydroxyzine) for pruritus/insomnia.
   Dose: 10–25 mg at night as needed, short courses.
   Purpose: reduces itch and helps sleep while antipsychotics engage.
   Side effects: drowsiness, anticholinergic effects—use sparingly. NCBI

9. Topical ophthalmic therapy for injuries (per eye doctor).
   Examples: preservative-free lubricants frequently; short courses of antibiotic drops/ointments if abrasions/secondary infection; avoid steroid monotherapy unless supervised.
   Purpose: protect the cornea and lid skin while behavior change is underway. American Academy of Ophthalmology

10. Depot/long-acting antipsychotic formulations (e.g., risperidone LAI) if adherence is very poor.
    Purpose: steady dosing reduces relapse.
    Note: consider only after shared decision-making with psychiatry. NCBI

Evidence snapshot: Systematic reviews and practice summaries report 60–100% partial/complete response with atypical antipsychotics in delusional infestation, though controlled trials are limited. Safer second-generation agents are preferred over pimozide. NCBIPubMed

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Dietary / molecular supplements

Safety first: Use supplements only as add-ons to medical care, ideally after labs. Avoid megadoses and check interactions with your doctor.

1. Vitamin B12 (if low): 1,000 mcg/day oral or as advised if deficiency is confirmed. Function: corrects neurologic symptoms; Mechanism: supports myelin and neurotransmitter synthesis. PMC

2. Folate (B9) (if low): 400–800 mcg/day; doctor may use prescription folinic acid in special cases. Function: one-carbon metabolism; Mechanism: neurotransmitter synthesis. NCBI

3. Vitamin D (if low): dose varies (often 1,000–2,000 IU/day; follow labs). Function: brain/immune signaling; Evidence: deficiency links to psychosis risk; supplementation did not improve early psychosis outcomes in one RCT—use to correct deficiency, not as a treatment. PMCJAMA Network

4. Omega-3 (EPA/DHA): 1–2 g/day combined EPA+DHA with meals. Function: anti-inflammatory membrane lipids; Evidence: adjunct data are mixed/inconclusive for psychosis; may help dry-eye in some, though trials conflict—discuss with your clinician. PMC

5. N-Acetylcysteine (NAC): commonly 600 mg twice daily (some studies 1,200 mg twice daily). Function: glutathione precursor; Mechanism: modulates glutamate and oxidative stress; RCTs show benefit as adjunct in schizophrenia for some domains. PubMedPMC

6. Magnesium glycinate: 200–400 mg in the evening. Function: sleep/anxiety support; Mechanism: NMDA/GABA modulation; avoid in kidney disease. (Supportive evidence; general, not DI-specific.)

7. Melatonin: 1–3 mg 1–2 hours before bed. Function: circadian support; Mechanism: resets sleep timing; may ease nighttime checking. (General psychosis care practice.) NICE

8. Thiamine (B1): 50–100 mg/day if nutritionally at risk or with alcohol-use history. Function: neuronal energy metabolism.

9. L-theanine: 200 mg once or twice daily. Function: reduces anxiety; Mechanism: alpha-wave promotion; caution with sedatives. (Adjunctive evidence in anxiety states.)

10. Probiotic foods or supplements: dose per product. Function: gut–brain axis support; Mechanism: may modestly influence inflammation/stress reactivity; evidence is emerging.

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Regenerative / stem-cell” drugs

There are no approved “immunity-booster” or stem-cell drugs for ophthalmic delusional parasitosis or delusional infestation. Using such products for this condition would be experimental and inappropriate. Instead, when the ocular surface is injured from rubbing/picking, ophthalmologists may use regenerative biologic treatments to heal the cornea:

• Autologous serum eye drops (ASEDs): made from the patient’s blood serum; dose often 20%–100% drops, 4–8×/day; function: supply growth factors and vitamins similar to tears; mechanism: promotes epithelial healing in severe dry eye or persistent epithelial defects. PMC

• Platelet-rich plasma (PRP) eye drops: similar concept with platelet growth factors; used in specialty centers (dosing per protocol).

• Amniotic membrane (cryopreserved/sutureless devices): placed on the eye to speed re-epithelialization and calm inflammation when abrasions/ulcers won’t heal; not a “drug,” but a regenerative tissue therapy. Annals of Eye Science

If you were specifically seeking “stem-cell drugs,” I can’t recommend any for this condition because none are evidence-based or approved. Safer regenerative eye-surface options above are what specialists use for injury, not for the delusion itself. Annals of Eye Science

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Surgeries/procedures

1. Bandage contact lens for corneal abrasions that keep reopening—protects the surface while it heals.

2. Amniotic membrane transplantation (or sutureless device)—biologic “patch” to heal stubborn epithelial defects. Annals of Eye Science

3. Temporary tarsorrhaphy—gently sewing lids partially closed to shield the cornea in severe exposure/scratch cycles.

4. Corneal debridement with medical therapy—cleans unhealthy epithelium to allow healthy regrowth when supervised by a cornea specialist.

5. Repair of lacerations / treatment of infections—if self-inflicted trauma leads to a cut or ulcer, urgent surgical/medical care prevents vision loss. (These steps address complications documented in ophthalmic DI case reports.) ScienceDirect

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Prevention tips

1. Build a care team (eye doctor + primary care + psychiatry).

2. Sleep on a schedule; protect 7–8 hours/night. NICE

3. Limit eye irritants (smoke, strong cleaners, dusty fans/AC). AAO Journal

4. Practice lid hygiene (warm compress + gentle wipe) not harsh chemicals. American Academy of Ophthalmology

5. Use preservative-free tears during screen time and in dry rooms. AAO Journal

6. Avoid picking/scraping tools; switch to safe routines coached by your eye doctor.

7. Avoid stimulants and recreational drugs; get help for alcohol misuse. NCBI

8. Correct nutritional deficiencies (B12/folate/Vit D) if labs show they’re low. PMC+1

9. Manage stress (brief daily relaxation/training).

10. Keep regular follow-ups and a written relapse plan.

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When to see a doctor—right away or soon

• Right away (urgent ophthalmology): sudden eye pain, light sensitivity, new blurred vision, discharge, a corneal scratch that doesn’t improve in 24–48 h, or any chemical exposure to the eye. (Complications can escalate quickly.) ScienceDirect

• Soon (within days): persistent crawling/biting feelings around the eyes for >1–2 weeks, inability to stop rubbing/picking, or any eyelid skin breakdown.

• Soon with primary care/psychiatry: low mood, high anxiety, insomnia, stimulant/other substance use, or a belief that is taking over daily life; get evaluation for thyroid, B12/folate, infections, and medication effects. NCBI

• Emergency: thoughts of harming yourself or others—seek urgent mental-health help.

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What to eat—and what to avoid

What to eat 

1. Balanced plate: half vegetables/fruit, quarter protein, quarter whole grains.

2. Omega-3–rich fish (e.g., sardines, salmon) 1–2×/week for general anti-inflammatory benefits. (Adjunct evidence for psychosis is mixed; fish is still heart-healthy.) PMC

3. B-vitamin sources: eggs, dairy, fish, leafy greens, legumes (supports nerve health).

4. Hydration: steady water intake; dehydration worsens dry-eye sensations.

5. Fermented foods (yogurt, kefir, kimchi) for gut–brain support.

6. Nuts/seeds for magnesium and healthy fats.

7. Colorful produce (antioxidants) daily.

8. Lean proteins to stabilize energy and mood.

9. Whole grains for sustained energy (reduces jitteriness).

10. Caffeine-sensible plan (small/morning only) to protect sleep.

What to avoid/limit 

1. Stimulants and recreational drugs (strongly linked to tactile hallucinations). NCBI

2. Excess alcohol (withdrawal can worsen formication). NCBI

3. Harsh eye “home remedies” (peroxide, bleach, alkali, irritant oils).

4. Highly processed, high-sugar foods (sleep/mood disruption).

5. Very spicy/irritant fumes while cooking (eye irritation).

6. Late-night caffeine/energy drinks (sleep sabotage). NICE

7. Smoking/vaping (ocular-surface dryness). AAO Journal

8. Random supplements without labs (risk of interactions).

9. Overuse of vasoconstrictor eye drops (rebound redness).

10. Screen marathons without breaks (blink rate falls; use 20-20-20 rule).

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Frequently asked questions

1) Is this “all in my head”?
No—the distress and sensations are real. The problem is how the brain interprets them. Treatment aims to relieve symptoms, protect your eyes, and reduce the fixed belief over time. NCBI

2) Can real eye problems trigger it?
Yes. Dry eye, blepharitis, or Demodex irritation can start real itch/burn. After treatment, some people still feel convinced “bugs remain.” That’s when the delusional part persists. American Academy of OphthalmologyPubMed

3) What proves it’s a delusion and not parasites?
Repeated normal exams, negative scrapings/tests, and no response to parasite therapy point away from infestation. The belief lasts ≥1 month and resists evidence. Medscape

4) Do antipsychotic medicines really help this?
Yes—reviews show many patients improve with modern antipsychotics, at modest doses, when used kindly and consistently. PubMed

5) Which medicine is best?
Doctors often start with risperidone, olanzapine, quetiapine, or aripiprazole and choose based on your health risks (e.g., weight, diabetes, heart rhythm). Old drugs like pimozide are not first-line due to heart/neurologic side effects. NCBIPMC

6) How long before I feel better?
Commonly 2–6 weeks for distress to ease; beliefs may loosen gradually. (Your plan will set realistic checkpoints.)

7) Will I need these medicines forever?
Not always. Some people taper after steady improvement; some need longer maintenance. Relapses can respond again to the same treatment. NCBI

8) Can therapy work without medicines?
Sometimes, especially if symptoms are mild and you have strong support. For moderate or severe cases, medicine + therapy is usually more effective. PMC

9) Are “immune boosters” or stem-cell treatments helpful?
No—there are no approved or proven immune or stem-cell drugs for this condition. For eye injuries, doctors may use autologous serum drops or amniotic membrane to heal the surface—but those treat damage, not the delusion. PMCAnnals of Eye Science

10) Why avoid stimulant drugs and fix sleep?
Stimulants and sleep loss both increase misperception and fuel worry; improving sleep and stopping stimulants often reduce crawling sensations. NCBINICE

11) What if my family doesn’t believe me—or believes the same thing?
Family sessions help reduce conflict and “proof cycles.” In rare shared delusions, separate evaluation and gentle education for each person are important. PMC

12) Could vitamin problems cause this?
Yes—B12/folate deficiency can cause neuro-psychiatric symptoms. Testing and guided replacement are simple and important. PMC

13) Is Demodex always a delusion?
No—Demodex mites do exist and sometimes inflame lids. A clinician can test and treat when confirmed. But not every “crawling” feeling is Demodex. Evidence for tea-tree-based care is uncertain and stronger concentrations can sting. PubMed

14) Could this damage my eyesight?
It can—if rubbing, chemicals, or tools injure the cornea. Quick ophthalmic care prevents most complications. ScienceDirect

15) What’s the single most important first step?
Protect your eyes (no harsh chemicals or tools), book a combined eye + primary-care visit to check for secondary causes, and be open to a gentle, stepwise plan that includes therapy—and medicine if needed. NCBI

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 17, 2025.

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