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To investigate the meibomian gland (MG) performance in patients with glaucoma under topical intraocular pressure (IOP)-lowering medications.This was a cross-sectional case-control study. Patients with glaucoma under different dosages and instillation periods of topical IOP-lowering medications were included. A total of 30 eyes out of 30 healthy participants and 85 eyes out of 85 patients with glaucoma were analyzed. The burden of instilling antiglaucoma agents [burden of antiglaucoma (BAG)] was simply scored for each participant based on the number, formula, frequency, and duration of topical IOP-lowering medications used. All participants completed the MG and tear assessments, including Standard Patient Evaluation of Eye Dryness questionnaire, lipid layer thickness, MG secretion and dropout, Schirmer test, tear break-up time, and blinking patterns.Patients with glaucoma had significantly lower Standard Patient Evaluation of Eye Dryness scores, thinner lipid layer thickness, worse mebium quality, and lower MG secretion compared with healthy participants. Among the patients with glaucoma, MG loss ratio (P=0.006) and meiboscale (P=0.017) were significantly correlated with the BAG score. Compared with the low BAG group (score <80), the high BAG group (score ≥80) had significantly shorter tear break-up time (P=0.047), lower MG density (P=0.032), higher MG loss ratio (P=0.011), and higher meiboscale (P=0.036).Patients with a higher BAG agents had more unstable tear films and more severe MG dropout. Therefore, MG disease should be particularly observed in patients with glaucoma following a higher BAG regimen.