What is your approach to treatment for recalcitrant MGD?

Recalcitrant MGD is a frequently seen clinical problem, especially in older patients. Standard treatment encompasses warm compresses and lid hygiene. The latter can be performed with over-the-counter lid wipes or simply with baby shampoo. Tropical antibiotics such as Polytrim drops and bacitracin/polymyxin ointment are frequently used. Short courses of topical corticosteroids may be appropriate as well. If these topical treatments are not effective, I always give early consideration to doxycycline orally. In such cases, the doxycycline is not used for its antibacterial effects but rather for its anti-inflammatory effects on the inflammatogenic properties of the meibomian gland secretions. Doxycycline is well-tolerated and can be used on a r...