Meibomian gland dysfunction(MGD)and dry eye disease(DED)are prevalent ocular surface disorders, with MGD being a primary cause of DED. Although multiple observational studies, systematic reviews, and Meta-analysis have found that dyslipidemia may be associated with the rising risk of DED and MGD, the mechanisms remain unclear, and these findings have been not yet fully incorporated into Chinese expert consensus on dry eye and MGD. The article begins by comparing the similarities and differences between meibum and blood lipids in terms of composition, and their age-related trends, noting that changes in meibum composition are more likely a result of MGD rather than alterations in blood lipids. Then we systematically review epidemiological evidence revealing the association between dyslipidemia and MGD/DED, delving into the underlying pathophysiological mechanisms. Finally, we evaluate the treatment prospects as well as controversies of lipid-lowering agents on their dual mechanisms of lipid-lowering and anti-inflammatory effects. This review aims to systemically integrate current research findings, elucidate gaps and contradictions, and provide a theoretical foundation for future exploration of blood lipids' role in ocular surface homeostasis, thereby advancing systemic prevention and treatment strategies for DED and MGD.