title: Blinking and tear break-up during four visual tasks.
abstract: OBJECTIVE
  This study investigates the relationship between blinking, tear film break-up, and ocular symptoms for normal and dry eye subjects performing four different visual tasks.
  
  
  METHODS
  Sixteen control and sixteen dry eye subjects performed four visual tasks (looking straight ahead, watching a movie, identifying rapidly changing letters, and playing a computer game) while blink patterns and fluorescein images of the tear film were videotaped. Pre and posttesting symptom questionnaires, querying the intensity of nine symptoms of ocular irritation, were completed by all subjects. Blink rate and blink amplitude were computed from digitized videos. The percentage of tear film break-up before the blink was calculated.
  
  
  RESULTS
  Dry eye subjects had a significantly higher blink rate (p = 0.017, t-test). Both groups blinked significantly less during the game and letter tasks (p < 0.04, t-test). Partial blinks were common as were clusters or "flurries" of rapid blinks, but there was no significant difference in blink amplitude for control and dry eye subjects. Tear film break-up in normal subjects was typically inferior; whereas dry eye subjects showed more tear break-up centrally and superiorly. Real-time video recording of tear break-up and blink behavior pointed to complex interaction between the two. Dry eye subjects shifted more toward intense ocular symptoms at posttesting (p < 0.05, Wilcoxon signed rank) than controls. Both groups showed a shift toward more corneal staining at posttesting (p < 0.05, Wilcoxon signed rank), which was typically inferior.
  
  
  CONCLUSIONS
  Reduced and incomplete blinking along with increased tear film break-up during normal visual tasks may explain the increased level of ocular discomfort symptoms reported at the end of the day, particularly in dry eye patients.
authors.affiliation: Indiana University School of Optometry, Bloomington, Indiana 47405, USA. nhimebau@indiana.edu
authors.forename: Nikole L
authors.initials: NL
authors.lastname: Himebaugh
authors.forename: Carolyn G
authors.initials: CG
authors.lastname: Begley
authors.forename: Arthur
authors.initials: A
authors.lastname: Bradley
authors.forename: Jenni A
authors.initials: JA
authors.lastname: Wilkinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001767:Blinking / Q000502:physiology*; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013666:Tears / Q000378:metabolism*; D014741:Video Recording; D014787:Vision Tests / Q000379:methods*; D055815:Young Adult