Lazy Blink – Not Always the Patient’s Fault 

It has been quite some time now, that eye care professionals (ECP) have been encouraging patients to blink fully and frequently to continually renew the ocular surface to a smooth and pristine state in order to maintain clarity and consistency of vision.  With the use of technology, ECPs are now able to analyze blink rates, blink quality and more specifically, the mechanism of the blink.  

I discovered an interesting phenomenon with one of my patients during a recent visit.  She had mild meibomian gland truncation, so I brought her back for computerized blink analysis using the LipiView II (Johnson & Johnson).  The LipiView II allows us to quantify a patient’s lipid layer thickness and analyze how many blinks are produced over a 20 second interval.  Even more revealing is whether those blinks are partial or complete—do the upper and lower lids touch in an effort to naturally express the meibomian glands?  The video capture can be further broken down into a frame-by-frame analysis and shown to the patient for educational purposes.  While I have traditionally blamed incomplete blinks on “lazy” blinking, I have come to discover this sometimes also occurs as a result of a mild ectropion of the lower lid during the blink itself (see figures 1a and b).  If such technology is unavailable in a practice, this phenomenon also can be visualized via sodium fluorescien pooling in the tear meniscus upon blinking and enhanced with the use of slit lamp video capture. 

This particular type of ‘blink ectropion’ may be caused by the development of lower lid laxity due to age or mechanisms related to years of RGP removal and make-up use etc.1  My intrigue in this area caused me to investigate radio frequency thermal treatment (RFTT).  The basic premise is that RFTT helps strengthen collagen bonds of the periorbital skin which brings the lower lid into better apposition to create a more full and forceful blink.2  An added benefit is that patients also enjoy a non-invasive approach to reducing under-eye bags, and fine lines and wrinkles.3  The treatment is simple, non-invasive, and takes about 10-15 minutes per eye.  It can be conducted by the doctor or a well-trained technician.  Ultrasound gel is applied generously around the periorbital area and a stylus-like probe is massaged in a circular fashion around the orbital rim while the temperature is slowly increased to 105°F. Boney prominences and the globe itself are avoided and there are no restrictions following the procedure.

in the image above the arrows point toward the reflection of the tears and space between the lid and eye

in the image above the arrows point to just one frame later as the upper lid starts to come down and the area between the lower lid and the eye starts to widen (seen in the reflection of the tears)