Quality, Reliability, And Readability Of Online Information On Blepharitis: A Cross-Sectional Assessment Using Jama, Discern, And Honcode Criteria

To evaluate the quality, reliability, and readability of patient-directed websites providing information on blepharitis. Blepharitis is a highly prevalent chronic eyelid condition, and patients increasingly seek online health information before or after clinical consultations. However, the accuracy, completeness, and accessibility of web-based content remains poorly characterized. This study aims to assess whether online blepharitis information meets recommended standards for quality, reliability, and health literacy, and to compare performance across different source types.

Cross-sectional analysis of English-language websites retrieved using the search term "blepharitis" conducted in February 2026. Websites were evaluated by two independent reviewers using validated quality and readability assessment instruments.

The first 50 patient-directed English-language websites on blepharitis were identified and categorized by source type (institutional 60%, information portal 24%, commercial 16%). Quality was assessed using JAMA benchmarks (0-4), DISCERN instrument (16-80), and HONcode principles (0-8). Readability was evaluated using five validated indices: Flesch-Kincaid Reading Ease and Grade Level, Gunning Fog, SMOG, and Coleman-Liau. Content analysis documented discussion of pathogenesis, management options, and red flag symptoms. Inter-rater reliability was calculated and mean scores between reviewers were used for analysis.

Fifty websites were analyzed with median word count 1290 (IQR 704-2736). Mean quality scores were: JAMA 1.38±0.98/4, DISCERN 44.88±8.50/80, and HONcode 3.78±0.99/8. Mean Flesch-Kincaid Reading Ease was 41.7±17.4 (difficult reading level), with only 6% of websites achieving ≥60 (fairly easy threshold). Mean Flesch-Kincaid Grade Level was 11.7±2.6, with only 4% at recommended ≤8th grade level. Other readability indices confirmed high complexity: Gunning Fog 13.6±2.6, SMOG 10.3±1.8, Coleman-Liau 14.9±3.0. Content analysis showed 88% discussed pathogenesis, 92% mentioned management, but only 24% included red flag warnings and 24% mentioned Demodex.

Online information on blepharitis demonstrates moderate quality and reliability but poor readability, with 96% of websites written above the recommended 8th-grade reading level. This exceeds health literacy capabilities of most patients and may limit comprehension and treatment adherence. Quality scores across all three validated instruments indicate substantial room for improvement in authorship transparency, evidence attribution, and complete treatment information. The paucity of red flag symptoms and limited Demodex discussion represents significant educational gaps. Clinicians should direct patients toward high-quality, readable institutional sources and consider these literacy barriers when counseling patients who use online resources.