Inflammation has been implicated in the pathogenesis of dry eye disease (DED)1,2, most notably in conditions such as Sjögren’s syndrome. However, in meibomian gland disease, considered the most common cause of dry eye, a lack of evidence confirming inflammation within the glands, suggests that ocular surface inflammation in this condition exists as a sequela of ocular surface insult. Indeed, in the context of the self-perpetuating nature of dry eye disease, it is not inconceivable that both initiating and downstream inflammation can occur³-⁵.
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