The most prevalent cause of dry eye disease (DED) is dysfunction of the meibomian glands (MGD). MGD is a multifactorial disorder with eyelid inflammation, microbial growth, skin disorders associated with it, and potentially severe corneal complications. MGD may be the result of any combination of the five distinct pathophysiological mechanisms listed below, making it likely that it is a heterogeneous condition: eyelid inflammation, conjunctival inflammation, damage to the cornea, changes in the microbiome, and DED brought on by unstable tear film A "vicious circle" can be used to describe both MGD and DED's pathogenesis: DED and MGD's underlying pathophysiological mechanisms interact, creating a double-whammy. Changes in microbiology can self-stimulate the MGD cycle, causing meibum to melt at a higher temperature and meibomian gland blockage, both of which reinforce the MGD cycle. The two vicious circles are directly connected by inflammation, dropout, and blockage of the meibomian gland. The hyperosmolarity and inflammation that are both a cause and a result of DED are brought on by MGD-associated tear film instability, which serves as a doorway into the DED cycle. To better pinpoint the underlying pathological mechanisms and enable more precise therapeutic targeting, we present a brand-new pathophysiological model for MGD. MGD may be considered a disease rather than merely a dysfunction if this scheme is better understood.