In the blink of an eye, our eyelids provide the ocular surface (cornea and conjunctiva) its first line of defense against external damage. But blinking serves another vital function, protecting the eye from drying out.
Every blink spreads the thin tear film evenly over the ocular surface—lubricating, cleaning, nourishing, and preventing inflammation and infection. Without this, the cornea can be exposed to drying conditions too long after the tear breakup time and develop dry spots and inflammation. A vicious cycle occurs where more drying is followed by more symptoms and inflammation, and then more drying. Many factors can contribute to dry eye disease; among the many factors, tear film destabilization due to low blink rate or poor blink mechanics plays a role. The number one cause of dry eye disease is meibomian gland dysfunction. These glands produce the lipid layer of the tear film that prevents basal tears from evaporating too quickly. Blinking produces more meibomian gland lipid secretions, increasing the lipid layer thickness. Additionally, blinking allows for the distribution of tarsal goblet cell mucin, the tear film layer responsible for tear film stability. Changes in the mucin layer may lead to enhanced tear evaporation. Those who spend prolonged periods using digital devices are prone to poor blinking habits and ocular surface drying from reduced blinking frequency. Doing blinking exercises routinely throughout the day helps to form regular and complete blinking habit patterns. Regularly practicing blinking exercises allows us to be proactive in ensuring consistent tear replenishment. In addition, blink exercises improve ocular surface health by expressing the meibum from the meibomian glands so that our tear film has a healthy balance of lipids. We have all heard of the 20-20-20 rule recommendation to look in the distance (20 feet) every 20 minutes for 20 seconds. It may be helpful to add blinking exercises to this routine.
Dr. Abelson, a clinical professor of ophthalmology at Harvard Medical School and senior clinical scientist at Schepens Eye Research Institute who consults in ophthalmic pharmaceuticals states, “Careful observation and documentation of blink biology is a crucial step in understanding, treating and preventing diseases such as ocular allergy and dry eye. Continuing research in this therapeutic area is essential, and it’s clear that we have a lot to learn about blinks.”
I have watched my dry eye disease (DED) progress for years. While LipiFlow and BlephEx have vastly improved my condition, I am looking forward to trying the StimulEyes regenerative eye drops and am hopeful of further improvement. As you might imagine, after years of suffering from dry eye disease, I’ve read everything I can find on the subject. I was intrigued to learn the effect of blinking on dry eyes, hence this article.
Check out our CE titled “Regenerative Medicine - Renewed Hope for Dry Eye Disease Treatment” in this issue and learn more about dry eye disease and a breakthrough treatment.
• Deborah Kotob
Pro to Pro Director