Serious Complications of Blepharitis
Corneal perforation is the most serious complication of blepharitis, particularly in children, though it can also lead to vision loss through corneal scarring, neovascularization, and keratopathy in both adults and children. 1
Vision-Threatening Corneal Complications
The most severe complications involve progressive corneal damage:
- Corneal ulceration and perforation represent the most catastrophic outcomes, with children at significantly higher risk than adults 1
- Corneal scarring and neovascularization can develop from chronic inflammation, leading to permanent vision impairment 1
- Superficial punctate keratopathy progresses to more severe corneal involvement, especially in patients with ocular rosacea and severe blepharitis 1
- Marginal corneal infiltrates and peripheral epithelial defects occur particularly with staphylococcal blepharitis 1
Structural Eyelid Complications
Chronic blepharitis causes permanent anatomical changes:
- Eyelash loss (madarosis) results from chronic inflammation, particularly in severe staphylococcal blepharitis 1
- Eyelid scarring with trichiasis (misdirected lashes) develops over time and can further traumatize the cornea 1
- Meibomian gland atrophy and fibrosis leads to irreversible loss of gland function 1
- Conjunctival cicatricial changes may indicate underlying malignancy or immune-mediated disease requiring urgent evaluation 1
Pediatric-Specific Complications
Children face unique and more severe risks:
- Amblyopia (permanent vision loss) can develop from chronic inflammation and induced refractive errors 1
- Induced astigmatism from chronic lid inflammation affects visual development 1
- Higher incidence of corneal perforation compared to adults, making pediatric blepharitis particularly dangerous 1
- Corneal melting occurs more frequently in children with ocular rosacea-associated blepharitis 1
Critical Red Flags Requiring Urgent Evaluation
When blepharitis presents with eyelash loss and/or conjunctival cicatricial changes, carcinoma or immune-mediated diseases must be ruled out immediately, as early diagnosis can be lifesaving. 1
Common Pitfalls
The American Academy of Ophthalmology emphasizes that while blepharitis is generally not sight-threatening, failure to recognize and treat severe cases—especially in children—can result in permanent vision loss 1. The chronic nature and subtle progression of complications means that seemingly mild disease can lead to irreversible structural damage if left unmanaged 1.