A blink efficiency exercise handout has been developed for practitioners to use when educating patients who have dry eye or dry contact lens symptoms.
Although blink efficiency is an essential part of the lacrimal functional unit, it has too frequently not received enough attention from clinicians who are focussed on remediating other tear dysfunctions.1 However, researchers have been increasingly interested in blink performance with multiple studies showing how anomalies, such as an abnormally high ratio of incomplete blinks, can detract significantly from blink efficiency and efforts to reduce dry eye or dry contact lens symptoms. Complaints of discomfort and dryness are very common so that blink efficiency exercises have great potential for helping many patients. However, to achieve good outcomes, the action of giving patients a handout with instructions for improving blink efficiency most definitely needs to be supported by an explanation of the importance of efficient blinking in the maintenance of tear functions, as well as guidance as to how exercises can be performed appropriately.
Consulting room time can be saved if support staff are trained to demonstrate an efficient blink practice session so that patients can leave having learnt how to perform blink efficiency exercises as specified in their handout (complete, soft, brief, natural). Having multiple descriptors for these specifications helps. For example, if a patient’s initial efforts are not soft enough (too much hard squeeze force involved) then describing the desired complete blink as light, relaxed and gentle can improve their understanding of what is required. It can help to add the comment that while their initial effort for ‘completeness’ was good, hard squeeze blinks take too long as well as looking unnatural compared to brief, quick, rapid blinks. In addition, it might be worth noting that hard squeeze blinks can attract the wrong kind of attention from work colleagues or family members who observe a blink practice session.
Also, squeeze blinks have the disadvantage of elevating intraocular pressure to potentially pathological levels with associated harmful consequences for susceptible patients, such as those with, or at risk for developing a baropathic disease, including glaucoma and axial myopia as well as keratoconus or other ectatic disease.
Copies of the Blink Efficiency Exercises handout are available from: firstname.lastname@example.org.
Charles W McMonnies is an Honorary Professor at the School of Optometry and Vision Science, University of New South Wales.
- McMonnies CW. Diagnosis and remediation of blink inefficiency. Cont Lens Ant Eye; Published ahead of print May 2020.