Blepharitis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Blepharitis is usually asymptomatic until the disease progresses. As it progresses, the patient begins to notice a foreign body sensation, eyelid crusting, itching and irritation of the eyelids. If left untreated, severe blepharitis may cause alterations in the eyelid margin, loss of eyelashes, scarring of the eyelids, conjunctivitis, corneal involvement, superficial keratopathy, and ultimately blindness. Common complications of blepharitis include loss of eyelashes, hordeolum or stye, chalazion, corneal ulcer, and conjunctivitis. Blepharitis is generally associated with a favorable long-term prognosis.

Earlier in the course of blepharitis, patients may be asymptomatic and present with findings of eyelid margin telangiectasia and meibomian gland orifice narrowing.^[1] As the disease progresses, patients usually develop symptoms of foreign body sensation, eyelid crusting, matting of the lashes, tearing, and burning. If left untreated, blepharitis may lead to alterations in the eyelid margin, loss of eyelashes, scarring of the eyelids, corneal involvement (corneal neovascularization and scarring), superficial keratopathy, and eventually blindness.^[2][3]

Complications to blepharitis include:^[4][5][6]

• Hordeolum or stye
• Chalazia
• Corneal ulcer
• Conjunctivitis

In general, blepharitis is associated with a favorable long-term prognosis. Severe blepharitis is rarely associated with permanent alterations in the eyelid margin or vision loss from superficial keratopathy. However, severe blepharitis cases with these complications are generally associated with a poor p​rognosis​.^[7][8]