北卡罗莱纳州TearScience公司、波士顿 Korb Associates的David Murakami医师在美国眼科学院2014年会中发表研究结果。不完整眨眼和蒸发性乾眼症密切相关。
  所有病患都完成一份乾眼问卷,用LipiView (TearScience公司产品)测量泪膜脂质层的眼科成像装置,记录与分析20秒的习惯性眨眼行为。此外,用Meibomian Gland Evaluator (TearScience公司产品)测量下眼睑功能性睑板腺的数目。
  介入组的不完整眨眼百分比显著改善(70.9% vs 23.5%;P= .001),此外,症状减少(10.1 vs 6.7;P= .02)且功能性泪腺平均数目增加(4.1 vs 5.9;P= .02)。
  未参与此次研究的纽约市开业眼科医师Barry Farkas表示,对于多年未眨眼或不完整眨眼引起的乾眼症,眨眼运动是一个众所周知的解药。
  宾州大学Scheie眼科研究中心、Penn 乾眼暨眼球表面中心的Mina Massaro-Giordano医师表示,眨眼很重要。她表示她已经有注意到,她很惊讶病患有那么多人有不完整眨眼问题,她有建议一些病患进行眨眼运动。

Blinking Exercises Help Ease Evaporative Dry Eye

By Megan Brooks
Medscape Medical News

In patients with evaporative dry eye, blinking exercises can help decrease partial blinking and improve meibomian gland function and symptoms, according to a new study.

Detecting and quantifying partial blinking and blink training might be important in the overall treatment and management of evaporative dry eye, the investigators report.

David Murakami, MPH, OD, from TearScience Inc. in Morrisville, North Carolina, and Korb Associates in Boston, presented the results at the American Academy of Optometry 2014 Annual Meeting in Denver.

Partial blinking is closely involved in evaporative dry eye, he explained in an interview with Medscape Medical News.

"We are a focused society; we stare at computers, smartphones, and video games, and we are trained not to blink. If you aren't blinking fully, you don't express the oil from the glands," he said.

We have hundreds of patients with evaporative dry eye who are on a blinking program," Dr Murakami reported.

Blink and Brain Training

Dr Murakami presented results on 10 patients diagnosed with partial blinking, symptomatic evaporative dry eye, and reduced gland function. Their mean age was 53 years.

All patients completed a dry eye questionnaire, and habitual blinking behavior was recorded for 20 seconds and analyzed with the LipiView (TearScience Inc.), an ophthalmic imaging device used to measure the tear film lipid layer. In addition, the number of functional lower lid meibomian glands was determined with the Meibomian Gland Evaluator (TearScience Inc.).

Each patient was trained in and performed individualized blinking exercises for at least 8 weeks.

"I tell patients to really pause and deliberately close their eyes," Dr Murakami said. "We are training the lids to be stronger, but we are also retraining the brain to do a full blink." A blinking reminder computer program helped remind the patients to do the exercises.

Patients were assessed before and after the intervention.

The percentage of partial blinks improved significantly with the intervention (70.9% vs 23.5%; P = .001). In addition, symptoms decreased (10.1 vs 6.7; P = .02) and the average number of functional glands increased (4.1 vs 5.9; P = .02).

"Blinking exercises have been a well known antidote for dry eye symptoms due to non or partial blinking for many years," Barry Farkas, OD, an optometrist in private practice in New York City, who was not involved in the study.

"We have employed such assistance for over 35 years. In the old days of mostly rigid contact lenses, those exercises were even more necessary for tear and oxygen flow and exchange," he told Medscape Medical News.

Compliance an Issue

"In today's world, where contact lens materials are all breathable, complete blinking still remains more than helpful in spreading both moisture and nutrients to the entire corneal surface," Dr Farkas explained. "Even for those not wearing lenses, failure to blink completely and regularly can push a marginally unstable tear layer toward a too-short contact time with the cornea and lead to corneal surface breakdown."

"The issue with blinking exercises has always been, and remains, finding individuals motivated enough to learn the technique and continue with the process. There are those who might find the treatment not enough of a cure and too much of a nuisance," he said.

Dr Murakami said he agrees that compliance is "always going to be an issue." However, education is important. Patients who demonstrate more severe partial blinking and who tend to be very symptomatic are likely to be compliant because they understand the problem, he pointed out.

Blinking is "important", said Mina Massaro-Giordano, MD, from the Penn Dry Eye and Ocular Surface Center and the Scheie Eye Institute at the University of Pennsylvania in Philadelphia.

She said she has been paying more attention to it. "I was kind of surprised to see the amount of partial blinks my patients have. I do give blinking exercises to some of my patients," she told Medscape Medical News.

"What's interesting about this study," Dr Massaro-Giordano said, "is that it shows you can improve the muscles involved in blinking. It's just like any muscle; if you work it, it improves."

But she said it is also important consider the eyelids. "Older patients may have lax lids or extropion, so even if they are blinking hard, it may be ineffective because that lower lid is just loose from age, prior surgery, or prior damage," she explained.

"You also have to look at the meibum. If you have meibum that is completely socked in and the concretions are really dense and it's very viscous, then you can blink all you want — it's not coming out."

This study was funded by TearScience Inc. Dr Murakami and his coauthors are employees of the company. Dr Farkas and Dr Massaro-Giordano have disclosed no relevant financial relationships.

American Academy of Optometry 2014 Annual Meeting: Poster F-039. Presented November 14, 2014.

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