Effects of blinking exercises on palpebral fissure height and tear film parameters

Abstract

Purpose: Blinking is an involuntary movement essential for ocular surface health and visual comfort. While blinking exercises in patients with dry eye have been shown to improve symptoms, increase non-invasive tear film breakup time (NIBUT), and decrease incomplete blink rate (IBR), no studies have quantified improvements in eyelid opening. This study evaluated the effects of blinking exercises on palpebral fissure height (PFH), subjective symptoms, and tear film-related parameters.

Methods: Participants were randomly assigned to a "blinking exercise group" that performed blinking exercises after instilling artificial tear drops five times daily for three days or control group that only used artificial tear drops. Standard Patient Evaluation of Eye Dryness (SPEED) and Visual Analog Scale (VAS) scores were recorded for dryness, eye strain, ocular discomfort, blurred vision, foreign body sensation, dullness, and difficulty in opening the eyelids. The pre- and post-study measurements included lipid layer thickness, PFH, blink interval, IBR, tear meniscus height, NIBUT, fluorescein staining, and fluorescein breakup time (FBUT).

Results: Among 100 participants (28 males, 72 females, mean age 38.4 ± 7.4 years), 52 were in the blinking exercise group and 48 were in the control group. The blinking exercise group showed significant improvements in SPEED (P < 0.001), VAS scores for eye strain and discomfort (P = 0.003, 0.007), enlarged PFH (P < 0.001), prolonged NIBUT and FBUT (P < 0.001), and reduced IBR (P < 0.001) compared to the controls.

Conclusions: Blinking exercises improved PFH, incomplete blinking, tear film stability, and subjective symptoms in patients with dry eye.

Keywords: Blinking exercise; Dry eye; Incomplete blink; Meibomian gland; Meibomian gland dysfunction; Palpebral fissure; Tear film.