Objective This study aims to evaluate the clinical efficacy of 0.5% loteprednol etabonate ophthalmic suspension combined with meibomian gland probing in the treatment of severe obstructive meibomian gland dysfunction (MGD), with the goal of optimizing therapeutic strategies. Methods A total of 42 patients (84 eyes) diagnosed with?severe obstructive meibomian gland dysfunction (MGD)?who attended our ophthalmology outpatient clinic between October 2024 and February 2025 were recruited. Patients were?randomly allocated?to either the?treatment group?or the?control group, with 21 patients (42 eyes) in each group. All patients in both groups received?conventional therapy?(sodium hyaluronate eye drops?+?meibomian gland expression). The treatment group additionally received?0.5% loteprednol etabonate ophthalmic suspension?combined with?meibomian gland probing. The?treatment period?for both groups was 4 weeks.?Assessments?performed before and after treatment included:?Ocular Surface Disease Index (OSDI) score,?slit-lamp microscopic lid margin score,?meibomian gland dropout score,?fluorescein tear film breakup time (FBUT),?meibomian gland expressibility score, and?meibomian gland secretion quality score. Results After 4 weeks of treatment, all the aforementioned outcome measures except for FBUT were significantly lower than baseline (P < 0.05) in both groups, while FBUT was significantly higher than baseline (P < 0.05). The treatment group demonstrated significantly better outcomes in all clinical parameters compared to the control group. Conclusion The combined therapy of 0.5% loteprednol etabonate ophthalmic suspension and meibomian gland probing promotes the recovery of meibomian gland function in patients with severe obstructive meibomian gland dysfunction. This approach effectively improves meibomian lipid excretion and alleviates local inflammation, thereby significantly alleviating ocular dryness and other symptoms in patients.