Therapeutic benefits of blinking exercises in dry eye disease

•Digital screen exposure is known to adversely affect blink quality and frequency.•Blinking exercises are shown to modify poor blinking patterns.•Blinking exercises are shown to improve dry eye symptoms.•Blinking exercises result in changes in objective measures of tear film quality.•Consider incorporating a blink exercise routine into clinical care recommendations. Dry eye disease (DED) is an important public health concern given its increasing prevalence and impact on patient quality of life. Blinking frequency and completeness are reduced during digital screen exposure, compromising meibum secretion and distribution, causing tear film instability and leading to DED. This study evaluated the effects of blinking exercises on blink pattern and clinical signs and symptoms of DED. Fifty-four participants with dry eye symptoms received instructions to perform a ten-second cycle of blinking exercises every 20 min during waking hours for four weeks. Symptoms were assessed using the 5-item Dry Eye Questionnaire (DEQ-5) and Ocular Surface Disease Index (OSDI); blinking patterns measured with the TearScience LipiView II; and tear film and ocular surface parameters assessed with the Oculus Keratograph 5M. Measures at baseline and on day 28 were compared. Forty-one participants completed the study, reporting an average of 25.6 daily blinking exercise cycles. Improvements were noted in DEQ-5 (from 11 ± 4 to 7 ± 3; p < 0.001), OSDI (36 ± 18 to 22 ± 17; p < 0.001), non-invasive tear film breakup time (6.5 ± 2.4 to 8.1 ± 4.8 s; p < 0.04), the proportion of incomplete blinks (54 ± 36 to 34 ± 29 %; p < 0.001), but not in tear meniscus height or tear film lipid layer thickness. Blinking exercises can modify poor blinking patterns and improve dry eye symptomology, with modest changes in objective measures of tear film quality. Incorporating such routines into clinical care recommendations may improve blinking habits and help protect against the impact of digital device use on tear film quality and DED onset and evolution.