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To estimate the prevalence of meibomian gland dysfunction (MGD) in the Japanese population using new diagnostic criteria, including lid margin abnormalities and signs of occlusion of the meibomian gland orifices as essential signs.The participants were consecutive patients scheduled for cataract surgery at Inouye Eye Hospital. All participants were aged 50 years or older. The participants completed a symptoms questionnaire and underwent a comprehensive slit-lamp examination. MGD was diagnosed when both of the following 2 factors were positive: lid margin abnormalities and signs of occlusion of the meibomian gland orifices.The study included 510 participants (205 men, 305 women) of mean age 71.1 ± 8.5 (range 50–93) years. The prevalence rates of symptomatic MGD and total (symptomatic + asymptomatic) MGD were 18.0% and 47.5%, respectively. The prevalence of total MGD increased significantly with increasing patient age (P < 0.0001). The ratio of men to women and the prevalence of systemic disease did not differ between participants who were positive or negative for MGD. For the total MGD group, slit-lamp findings (lid margin abnormality, shift of the mucocutaneous junction, telangiectasia, and plugging) were more frequent; tear film breakup time was shorter; and the meiboscore was higher than in participants without MGD.The prevalence of MGD is high in the Japanese population aged 50 years or older.