paulBlinking Exercises

By: Paul M. Karpecki, OD, FAAO
Clinical Director – PECAA

It is said that one of the main causes of meibomian gland dysfunction (MGD) may well be tied to a patient’s blink rate. Theories suggest that the lack of a full or complete blink can result in less pumping activity of the lower eyelid meibomian glands, which are responsible for 78% of the oils in the tear film. A partial blink may be have many causes including lagophthalmos, use of digital devices, cosmetic surgery and simply an inability to blink that has been learned or developed over years. The average person using a computer blinks 4.4 times per minute as opposed to someone who is gazing (21 blinks per minute) or in conversation (over 30 blinks per minute).
The obstruction from the lack of a good blink rate should be managed with options ranging from commercial compresses such as the Bruder mask to lower eyelid debridement to Thermal pulsation such as LipiFlow. Inflammation should also be controlled with options ranging from Restasis, combination agents like Zylet to oral doxycycline or omega-fatty acid nutritional supplements. Lid hygiene should also be included such as OcuSoft Lid Scrub options, SteriLid or hypochlorus acid options to name a few. In-office BlephEx is an ideal mechanical treatment to assist with blepharitis and the biofilm that may be present on the eyelids. But the original cause is the blink rate so perhaps blink exercises as you see here might be of great benefit if patients are willing to implement this option.

Blinking Sequence

Close – Pause – Pause – Open – Relax
Close – Pause – Pause – Squeeze – Open – Relax
1. Hold your fingers at the corners of your eyes and blink. If you feel any movement under your fingers, you are using your defense muscles that run along the side of your head. Your blinking muscles are above the eyelids.
2. Read the blinking sequence. It is very important to do the squeeze step to stretch the blinking muscle so you can make complete contact between the upper and lower lids. When you are doing the exercises correctly you should feel no movement under your fingers except when you squeeze.
3. Blinking can be very task-dependent. For example, if you spend a lot of time on the computer, you are probably blinking much less frequently and might want to post a copy of the blinking exercises nearby. Other pastimes that decrease the blink rate are reading, driving, video games, etc.
4. In addition to consciously incorporating the blinking exercises into your schedule (i.e. 5x/hour) you might want to think about something that you do often in your daily routine, such as answering phone calls, sending emails, drinking sip of water, applying lip gloss, etc. If you can condition yourself to make a full blink and give a little squeeze every time you perform this action to help make it a habit.
Donald Korb, OD is credited in developing these blinking exercises.

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