The association of keratoconus with blepharitis

Background: 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. Methods: 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. Results: 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). Conclusions: 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.