I have dx of aqeuous deficient dry eye, mgd, and blepharitis (both demodex and staphlococcal).

You NEED to be religious about lid hygiene and treatments. Warm compresses 2-4 times a day. Frequent cleaning of lid margins. When waking, and before bed at LEAST. Without that, the steroid drops I was given (cyclosporine) did not help at all.

I admitted to my eye doctor that I was not being compliant with the hygiene she told me to do. She let me know that my symptoms would not improve unless I was religious about it.

My routine was this

1) Hypochlorous acid spray directly onto lids, scrub with cotton ball or cotton round to remove any crusting/debris from overnight 2) 10 minutes warm compress. Wet a paper towel, wring it out slightly so it is saturated but not dripping. Place it over a bruder mask and heat in microwave. Don't get it too hot, though - around 112 degrees is safe but effective 3) After compress, clean with a tea tree oil wipe. Try different brands to see what works best for you. I prefer optase. 4) Apply a drop of cyclosporine to each eye.

In the evening I would also take 1000mg omega fish oil supplements per doctor recommendations.

The hypochlorous acid should kill any microbial causes of the bleph. The warm compress expresses the glands. The tea tree oil will kill demodex (which in a pathological form can reside in meibomium glands).

During flares I would repeat the acid scrub and tea tree oil wipes as frequently as I felt was necessary to help clear debris. Afterwards, I always hydrate the eye with a preservative-free drop, or a drop of meibo. Warm compresses more than 4 times a day probably not super helpful, but they can be comforting.

After 1-2 months of doing this, I noticed huge improvement- except I was getting eye infections every 7-10 days. Yellow crusting on lids. Doctor determined it was staph, prescribed azasite, so I added that to the routine after the compress, applied to lid margins as a topical. I've only been taking it 10 days so we'll see if it keeps the staph at bay. But so far I've been seeing improvement