The exact pathogenesis of blepharitis is not fully understood. It is thought that blepharitis is caused by either bacterial colonization in the eyelids or meibomian gland dysfunction. Blepharitis may also be caused by allergens and mites that affect the eyelashes.^[1][2]

The exact pathogenesis of blepharitis is not fully understood. It is thought that blepharitis is caused by either bacterial colonization in the eyelids or meibomian gland dysfunction. However, in most cases of blepharitis, there is a considerable pathogenesis overlap between anterior and posterior blepharitis.

Anterior blepharitis is often associated with staphylococcal infection or seborrhoeic dermatitis. The exact pathogenesis of anterior blepharitis is not fully understood. It is thought that blepharitis is caused by bacterial colonization (Staphylococcus aureus or Staphylococcus epidermidis) in the eyelids. Following bacterial colonization, bacterial lipase changes meibomian gland secretions and increases cholesterol concentration. These changes may result in an environment that affects the ocular surface and tear evaporation. It is thought that anterior blepharitis may also be caused by allergic response to bacterial antigens (mostly staphylococcal antigens).^[1][2]

The exact pathogenesis of posterior blepharitis is not fully understood. It is thought that the abnormal meibomian gland secretions may result in posterior blepharitis. Posterior blepharitis is often associated with skin conditions, such as rosacea or seborrhoeic dermatitis. These conditions are associated with sebaceous glands and gland orifices abnormalities. It is thought that the abnormal meibomian gland secretions may cause a direct toxic effect on the ocular surface. Sebaceous glands abnormalities may also result in an environment that affect bacterial growth.^[3]

Acute blepharitis may be caused by irritant or allergen exposure.^[4]

Demodex folliculorum is an external parasite in hair follicles, sebaceous glands, and meibomian glands. It may cause either anterior or posterior blepharitis. The exact pathogenesis of chronic blepharitis caused by the Demodex mites is not fully understood. It is thought that over-proliferation of Demodex folliculorum in meibomian glands may result in lid-margin infection and ocular discomfort. It is also thought demodex blepharitis may be caused by immune system reactions to the mites leading to inflammation. ^[5][6]

Many diseases are associated with blepharitis such as skin, systemic, and ocular disease. These include:

• Systemic or skin disease:^[7][8]
  • Rosacea
  • Seborrheic dermatitis
  • Atopy
  • Systemic lupus erythematosus (SLE)
  • Sjögren’s syndrome
• Ocular disease:^[7][8][9]
  • Conjunctivitis
  • Meibomianitis (inflammation of the meibomian glands)
  • Keratitis
  • Dry eye syndrome
  • Chalazion
  • Trichiasis

On gross pathology, lid margin swelling, misdirection of lashes, loss of lashes, oily or greasy deposits and crusting of anterior lid margin, , and conjunctival hyperaemia are characteristic findings of blepharitis.^[10]

On microscopic histopathological analysis, non granulomatous inflammation with neutrophils, acanthosis, or parakeratosis are characteristic findings of staphylococcal blepharitis.^[11]

On microscopic histopathological analysis, hyperkeratinization of the meibomian gland ductal epithelium, mononuclear cellular infiltrates, and spongiosis in eyelids are characteristic findings of seborrheic blepharitis.^[12]

On microscopic histopathological analysis, chronic inflammatory changes, epithelial hyperplasia, and follicular plugging are characteristic findings of chronic blepharitis.^[13]

The following are gross images associated with blepharitis:

• 
  Blepharitis of the right eye – By clubtable – Own work (Original text: eigenes Foto), Public Domain, https://commons.wikimedia.org/w/index.php?curid=20138102
• 
  Infant with blepharitis – By Sage Ross – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=8978907