The International Workshop on Meibomian Gland Dysfunction (MGD) was convened by the Tear Film and Ocular Surface Society (TFOS) to address the lack of consensus on the definition, classification, diagnosis, and therapy of MGD. The workshop, which took over two years to complete, involved more than 50 leading experts from around the world. The report, published in multiple languages, outlines the evidence-based evaluation of MGD, including its definition, classification, anatomy, physiology, pathophysiology, epidemiology, diagnosis, and management. **Definition and Classification:** MGD is characterized by terminal duct obstruction and changes in glandular secretion, leading to tear film alterations, eye irritation, inflammation, and ocular surface disease. It is classified into low-delivery and high-delivery states based on meibum secretion, with subcategories for hyposecretory and obstructive conditions. **Anatomy, Physiology, and Pathophysiology:** Meibomian glands produce lipids that stabilize the tear film and prevent evaporation. Obstruction in these glands can lead to reduced lipid availability, increased evaporation, and dry eye symptoms. **Tear Film Lipids and Lipid-Protein Interactions:** Meibomian gland secretions consist of polar and nonpolar lipids, which interact with proteins to influence the tear film's properties. These interactions are crucial for maintaining tear film stability and protecting the eye. **Epidemiology and Risk Factors:** MGD is more prevalent in Asian populations, with reported prevalence rates often exceeding 60%. Risk factors include ophthalmic conditions, systemic factors, and medications. The exact prevalence and natural history of MGD remain poorly understood. **Diagnosis:** Diagnosis of MGD involves a series of tests, including gland expression, meibography, and assessment of ocular surface damage and dry eye. A two-tiered approach is recommended for diagnosing MGD-related dry eye, distinguishing between generic dry eye and evaporative dry eye. **Management and Therapy:** Treatment options vary among eye care providers, and underdiagnosis is common. A staged treatment algorithm is proposed, focusing on improving meibum quality and expressibility. Systemic medications and topical treatments have specific side effects that must be considered. **Clinical Trials:** Clinical trials in MGD are limited by inconsistent terminology and methods. Future trials should aim to distinguish MGD from dry eye disease, evaluate the natural history, and develop alternative assessment methods. Prospective, randomized, controlled, and double-masked trials are recommended for future research.The International Workshop on Meibomian Gland Dysfunction (MGD) was convened by the Tear Film and Ocular Surface Society (TFOS) to address the lack of consensus on the definition, classification, diagnosis, and therapy of MGD. The workshop, which took over two years to complete, involved more than 50 leading experts from around the world. The report, published in multiple languages, outlines the evidence-based evaluation of MGD, including its definition, classification, anatomy, physiology, pathophysiology, epidemiology, diagnosis, and management. **Definition and Classification:** MGD is characterized by terminal duct obstruction and changes in glandular secretion, leading to tear film alterations, eye irritation, inflammation, and ocular surface disease. It is classified into low-delivery and high-delivery states based on meibum secretion, with subcategories for hyposecretory and obstructive conditions. **Anatomy, Physiology, and Pathophysiology:** Meibomian glands produce lipids that stabilize the tear film and prevent evaporation. Obstruction in these glands can lead to reduced lipid availability, increased evaporation, and dry eye symptoms. **Tear Film Lipids and Lipid-Protein Interactions:** Meibomian gland secretions consist of polar and nonpolar lipids, which interact with proteins to influence the tear film's properties. These interactions are crucial for maintaining tear film stability and protecting the eye. **Epidemiology and Risk Factors:** MGD is more prevalent in Asian populations, with reported prevalence rates often exceeding 60%. Risk factors include ophthalmic conditions, systemic factors, and medications. The exact prevalence and natural history of MGD remain poorly understood. **Diagnosis:** Diagnosis of MGD involves a series of tests, including gland expression, meibography, and assessment of ocular surface damage and dry eye. A two-tiered approach is recommended for diagnosing MGD-related dry eye, distinguishing between generic dry eye and evaporative dry eye. **Management and Therapy:** Treatment options vary among eye care providers, and underdiagnosis is common. A staged treatment algorithm is proposed, focusing on improving meibum quality and expressibility. Systemic medications and topical treatments have specific side effects that must be considered. **Clinical Trials:** Clinical trials in MGD are limited by inconsistent terminology and methods. Future trials should aim to distinguish MGD from dry eye disease, evaluate the natural history, and develop alternative assessment methods. Prospective, randomized, controlled, and double-masked trials are recommended for future research.