Good Hope, Heartlands, and Solihull Eye Clinics

Blepharokeratoconjunctivitis  in children

David Kinshuck & colleagues

What is blepharitis?

Blepharitis is the medical term for inflamed eyelids. The inflammation is like eczema of the skin, with red, scaly eyelids. You may notice tired, or gritty eyes, which may be uncomfortable in sunlight or a smoky atmosphere. They may be slightly red, and feel as though there is something in them. The eyelids have tiny glands in them, especially the lower lids. These glands make substances that mix with tears, and help the tears to spread across the eye. There may be fungi in the lids Eye 15, or demodex mite.


meibomian glands, diagram, side view

side view

meibomian glands, diagram, front view

front view









The glands in the eyelids shown in purple


This thin layer of tears lubricates the eyes, stops them drying out, and keeps them comfortable.


healthy tear film, side view

side view

healthy tear film, front view

front view









Evenly spreading tears: a comfortable eye

However, as you get older, and particularly if you have dry skin, these glands can block. As a result the glands do not make the chemicals that enables the tears to  spread evenly across the front of the eye. As a result, the tears break up, and dry patches develop develop on the surface of the eye. These patches make the eyes feel sore or gritty.

Blepharokeratoconjunctivitis (ocular rosacea) may occur in adults or children. There is often a long delay getting treatment.

  • Lid margin may not be inflamed, lids..anterior or posterior involvement.
  • may be asymptomatic
  • Chalazia..posterior lid
  • hypersensensitivity..anterior lid
  • lid...styes...staphyloccus contributes.
  • On the lids there is crusting, telangiectasia, phlyctentules  papillary hyperplasia, hyperaemia
  • corneal ...crystal, marginal infiltrates, punctate epitheliopathy, axial corneal scar, vascularisation, phlyctenules, thinning.
  • need to exclude Molluscum, allergic, chlamydia, ligneous conjunctivitis
  • there may be skin flakes; collarettes suggest demodex as below


poor tear film in blepharitis

side view

poor tear film in blepharitis

front view









Poorly spreading tears: dry patches develop on the surface of the eyes making them sore.



Blepharokeratoconjunctivitis in children

separate page



mixed (mainly anterior) blepharitis

This is a type of chronic conjunctivitis in children. Essentially conjunctivitis develops but does not get better with treatment, and there is also a blepharitis.

Treatment for children (after Tuft 2015)