How unusual is it for recurrent corneal erosion to be caused, at least in part, by blepharitis?

Recurrent corneal erosions can be caused by a variety of underlying problems ranging from a previous abrasion (a scratch or scrape on the cornea) to a corneal dystrophy (a genetic disorder in which foreign materials accumulate in the cornea, causing loss of vision or blurred vision). The common thread is that the top layer of the cornea—called the epithelium—is not tightly attached to the rest of the cornea and is easily peeled off in a very dry environment, such as when patients with severe blepharitis and dry eyes are sleeping. The epithelium may be more tightly attached to the inside of the eyelid, so when the patient wakes up in the middle of the night or in the morning and opens his or her eyes, the epithelium peels off.

There are a variety of nonsurgical treatments ranging from artificial tear gels or ointments at night to a medicine called Muro 128 which may prevent the abrasions from occurring. Other nonsurgical options can include a bandage contact lens, doxycycline, or topical steroids. There are also many surgical options including anterior stromal puncture (a procedure where tiny holes are made in the top layer of the cornea, which promote a more secure attachment to the layers underneath it), superficial keratectomy (a procedure that removes malfunctioning surface cells from the cornea), and phototherapeutic keratectomy (or PTK, a laser surgery that removes scar tissue and irregularities from the corneal surface).