SIGNIFICANCE Microblepharon exfoliation improved eyelid signs and tear film characteristics after a single in-office treatment in symptomatic contact lens wearers. PURPOSE The purpose of this study was to assess the effect of two eyelid hygiene treatments-microblepharon exfoliation and a hypoallergenic foam cleanser (LidHygenix)-on clinical signs of the eyelids, meibomian glands, and tear film in contact lens discomfort. METHODS A randomized, interventional, unmasked, crossover trial was conducted on 30 experienced daily-wear soft contact lens wearers. Assessment of clinical signs of the eyelid margin, meibomian gland morphology and secretion, and tear film biophysical properties was performed (baseline 1), and participants were randomly assigned to receive one of the two treatments (microblepharon exfoliation or foam cleansing using LidHygenix) as a single in-office procedure. Symptoms were evaluated using the Contact Lens Dry Eye Questionnaire-8 immediately after treatment, and assessment of all the study variables was repeated at the follow-up visit 7 to 10 days after treatment. After 28 to 30 days of washout, participants returned for reassessment of the study variables (baseline 2) and were crossed over to receive the alternate treatment. Follow-up was repeated 7 to 10 days after the second treatment. RESULTS Seven to 10 days after treatment with microblepharon exfoliation, symptomatic wearers showed significant improvement in anterior blepharitis (mean difference, 0.60; P =.04), lid wiper staining (0.50; P =.06), and lid-parallel conjunctival folds (0.68, P =.02) along with orifice capping (median difference, 0.65; P <.001), foam (0.90; P <.001), secretion volume (0.69; P <.001), quality (0.74; P <.001), and expressibility (0.49; P =.002), which were also clinically significant changes. However, in tear properties, significant improvements were observed in tear volume (LidHygenix,-1.25 mm; microblepharon exfoliation,-1.62 mm), break-up time (-0.14 seconds;-0.14 seconds), tear evaporation rate without contact lenses (21.52 g m -2 h; 45.43 g m -2 h), and lipid layer thickness (-20.61 nm;-25.13 nm) after both treatments but in symptomatic lens wearers only (P <.05). CONCLUSIONS Microblepharon exfoliation improved eyelid signs and tear film characteristics in symptomatic contact lens wearers after a single in-office treatment.