A 56-year-old woman presents with chronic irritation in both eyes. For the past 6 months, she has had red, itchy eyelids, a gritty or burning sensation, and intermittent blurred vision that improves after blinking. She reports excessive tearing and morning crusting of her eyelashes, often requiring warm water to open her eyes. Light sensitivity occurs during flare-ups. She denies acute eye pain or purulent discharge. Her medical history is significant for rosacea. On examination, both eyelid margins are erythematous with greasy-appearing scales at the lash line. The conjunctiva is mildly injected. The meibomian gland orifices appear plugged with thickened secretions, and several lashes have dandruff-like debris. No discrete nodules are noted. Visual acuity is normal.