Immortalized human meibomian gland epithelial cells (IHMGECs) were cultured in the presence or absence of 10% fetal bovine serum, according to published protocols.16 (link)–18 (link) After reaching 80 to 90% confluence (~ 5 × 10/6 (link) well), cells were exposed to ethanol vehicle, linolenic acid (ω-3, 10−5 M; Santa Cruz Biotechnology, Dallas, TX), linoleic acid (ω-6, 10−5 M; Sigma-Aldrich, St. Louis, MO) or linolenic and linoleic acids together (0.5×10−5+ 0.5×10−5M), for 5 to 7 days. Azithromycin (AZM, 10 μg/ml; Santa Cruz Biotechnology) was used as a positive control in all experiments, because this antibiotic has well-defined effects on both the proliferation and differentiation of IHMGECs.19 (link)–22 (link) Following treatment, cells were processed for enumerative, histological and biochemical procedures.