The association of keratoconus with blepharitis

Identifying potentially treatable risk factors for the progression of keratoconus is of great importance. The purpose of this study was to determine the association between blepharitis and keratoconus.

In this prospective, comparative, observational study, 50 keratoconus participants from the central district of the Clalit Health Services Health Maintenance Organization in Israel underwent comprehensive eye examination. Seventy-two healthy medical personnel of similar ages were randomly chosen as a control group. The signs and symptoms of blepharitis in each participant were assessed. A thorough survey of the eyelids (scales and foam on the eyelashes, missing eyelashes and expression of meibomian gland contents) was performed. All participants were required to complete two questionnaires: the Ocular Surface Disease Index questionnaire and a questionnaire regarding symptoms, signs and risk factors for blepharitis.

Blepharitis was more common in keratoconus participants than in the control group (24 per cent versus 2.8 per cent, p < 0.001). A higher proportion of keratoconus participants reported rubbing their eyes more than once a day (36 per cent versus 11.1 per cent, p = 0.002) as well as red and tired eyes (12 per cent versus zero per cent, p = 0.009). On external eye examination, signs of blepharitis and meibomian gland dysfunction were found more frequently in the keratoconus group (p < 0.05).

Signs and symptoms of blepharitis occur more often in keratoconus participants than in healthy individuals. Blepharitis-related inflammation and associated eye rubbing may contribute to disease progression.