Azithromycin for Meibomian Gland Disease

Inclusion Criteria: * Symptomatic Meibomian gland disease, defined as patient-reported ocular surface symptoms such as dryness, grittiness, foreign body sensation, or eye fatigue in combination with clinically identifiable Meibomian gland disease with Grade 2 or greater involvement on the Meibomian Gland Grading Scale (Section XV, item 2). * OSDI Score greater than or equal to 20 * Ability to give informed consent Exclusion Criteria: * Age less than 18 years * Allergy or intolerance to oral azithromycin or topical dexamethasone * Allergy or intolerance to the preservatives used in topical ophthalmic 0.1% dexamethasone: sodium bisulfite, phenylethyl alcohol, benzalkonium chloride * History of prolonged QT interval, history of torsades des pointes, congenital long QT syndrome, bradyarrhythmias, heart failure * Patients currently taking medications that prolong the QT interval (Table 1) * Aqueous deficiency dry eye defined as Schirmer's strip testing without anesthesia with £ 5mm of tears on two separate tests. * Ocular surface inflammatory disease, including cicatrizing conjunctivitis, graft versus host disease, Stevens Johnson syndrome * Atopic disease with ocular involvement * Limbal stem cell deficiency * Oral or topical ophthalmic antibiotic use within the last 90 days * Oral prednisone use \>5mg per day * Topical ophthalmic steroid use within the past 30 days * Topical ophthalmic anti-inflammatory (including non-steroidal anti-inflammatory medications, lifitegrast, or c…