Optimisation of blinking exercises for dry eye disease

Abstract

Purpose: Blinking exercises can reduce the signs and symptoms of dry eye disease, but the optimum technique, repetitions and repeats/day are unclear. Hence, this study used an instructional app to assess the best routine for blinking exercises. Method: In the optimisation stage, dryness symptoms with the Ocular Surface Disease Index (OSDI-6-item), Symptom Assessment Questionnaire iN Dry Eye (SANDE), and the time the eyes were comfortable for after a blink (the Blink Test) were assessed in 98 participants with dry eye before and after 2 weeks of blinking exercises, as well as 2 weeks after completing the blinking exercise routine. Participants were randomised between a squeeze and blink compared to blink only regimen, 2 to 4 repeats per day and 5 to 25 repetitions each time. A second efficacy study with 28 participants with dry eye disease assessed the optimum app parameters based on symptom severity and frequency, blink rate/completeness, tear film stability and volume, along with ocular surface staining over the same time period. Results: Overall, blinking exercises reduced symptomatology (p < 0.01). Including a squeeze step significantly reduced symptom frequency (p < 0.01). Forty repetitions spread over two time a day was more effective than 10 repetitions 4x/day (SANDE frequency p = 0.015). Fifteen repetitions was more effective than 5 repetitions 3x/day (SANDE frequency p = 0.008). Using the optimum blinking exercise routine of 15 repeats, 3x/day for 2 weeks, dry eye symptom severity (p = 0.001), frequency (p = 0.027), incomplete blinks (p < 0.001) and conjunctival staining (p = 0.041) significantly decreased. These readings mostly returned to baseline levels two weeks after finishing the blinking exercises (p > 0.05). However, there was no significant effect on the blink rate, non-invasive tear breakup time, tear meniscus height or corneal staining (p > 0.05). Conclusion: Fifteen repeats of close-squeeze-open cycles, 3x/day was the optimum blinking exercise routine, reducing symptoms, number of incomplete blinks and conjunctival staining.