OBJECTIVE: This study aimed to document the treatment success of eyelid hygiene with liposomal suspension using new diagnostic tools and to determine whether additional lipid substitution provided measurable benefits in meibomian gland dysfunction. METHODS: A single-center controlled, partially single masked study was conducted. Group A used eyelid hygiene only, whereas group B additionally applied a liposomal eye spray. Subjective perception using the Ocular Surface Disease Index (OSDI) questionnaire, measurement of tear film osmolarity, noninvasive tear film break-up time, assessment of the lipid layer, meibography, inspection of lid margins, assessment of the meibomian glands, and measurement of matrix-metallopeptidase-9 were collected at baseline and after 12 weeks. RESULTS: Eighty-two patients were included and randomized into two groups. Both groups showed a decrease in OSDI score ( P <
0.001), an increase in lipid layer thickness ( P <
0.001), significant improvement in the degree of loss of meibomian glands ( P <
0.001), in the damage pattern of the eyelid margins ( P <
0.001), in the quality of meibomian gland secretion, and in matrix-metallopeptidase-9 after 12 weeks. CONCLUSIONS: Our study confirms the success of treatment with eyelid hygiene measures using a liposomal suspension. The additional benefit of lipid substitution was not significant after 12 weeks of treatment.