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.