Inclusion Criteria:  age of at least 20 years. The diagnosis of obstructive MGD based on ocular symptoms, plugged gland oriﬁces, vascularity and irregularity of lid margins, and reduced meibum expression (meibum grade of .1, where grade 0 = clear meibum easily expressed, grade 1 = cloudy meibum expressed with mild pressure, grade 2 = cloudy meibum expressed with more than moderate pressure, and grade 3 = meibum could not be expressed even with strong pressure). failure of at least 3 types of conventional MGD therapy to improve symptoms or objective ﬁndings for at least 1 year before study treatment  Exclusion Criteria:  the presence of active skin lesions, skin cancer, or other speciﬁc skin pathology. active ocular infection or ocular inﬂammatory disease.