Abstract
To examine the role of incomplete blinking in contributing to blink inefficiency,
symptoms of dry eye and ocular surface disease. To review methods for diagnosing blink
inefficiency (including both reduced overall blink rate and increased incomplete blink
rate) and the role of remediation for efficient complete blinking as an essential
part of the lacrimal functional unit in maintaining tear homeostasis. Diagnosis and
remediation of blink inefficiency appear to have been somewhat misunderstood in the
management of dry eye disease. To the extent that a high incomplete blink rate ranks
in significance with low blink frequency in contributing to blink inefficiency, measures
and remediation of only total blink rate are of reduced usefulness in the diagnosis
and treatment of blink inefficiency-related ocular surface exposure, dry eye symptoms
and ocular surface disease. In addition, a patient’s blink performance during a biomicroscopy
or any other clinical assessment of blink efficiency, is unlikely to be characteristic
of or relevant to the blink inefficiency that develops and causes symptoms during
their various day-to-day activities. There appears to be a strong case for prescribing
blink efficiency exercises in the management of many cases of dry eye symptoms and
ocular surface disease. Remediation of spontaneous blink inefficiency may require
that a motor memory of voluntary complete, rapid, relaxed and natural looking blink
formation is established and maintained as the basis for efficient spontaneous blinking.
Voluntary forceful blinking may undermine the motor memory of efficient blinking and
risk the depletion of any reserves of lipid.
Keywords
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Article info
Publication history
Published online: June 01, 2020
Accepted:
April 27,
2020
Received in revised form:
April 23,
2020
Received:
January 14,
2020
Identification
Copyright
© 2020 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
