Aqueous tear deficiency, evaporative dry eye, and conjunctivochalasis can cause stress on the meibomian glands through excessive friction or pulling on the glands during blinking. This leads to meibomian gland dysfunction (MGD). The glands may atrophy over time or become inflamed, producing poor quality and quantity of meibum, leading to evaporative dry eye. In other words, evaporative dry eye, aqueous deficiency, and conjunctivolchalasis can cause and/or exacerbate evaporative dry eye. Yes, evaporative dry eye can make itself worse.