title: Tear lipid layer deficiency associated with incomplete blinking: a case report.
abstract: BACKGROUND
  Meibomian gland obstruction induces hyposecretion of tear film lipids, which results in lipid layer deficiency and evaporative dry eye. Unfortunately, the importance of blinking in meibomian gland dysfunction has been largely overlooked, and it is not known whether incomplete blinking causes tear lipid deficiency, even in the unobstructed meibomian glands.
  
  
  METHODS
  A 38-year-old woman suffering from foreign body sensations in her eyes was examined. The cornea was clear and tear secretion was normal. Lid margin abnormalities were not observed and the meibum was clear. However, the lipid layer was very thin, and the patient was given a diagnosis of incomplete blinking. The patient was made aware of her condition and asked to blink consciously and completely. After that, an immediate increase in lipid flow was observed.
  
  
  CONCLUSIONS
  Tear lipid layer deficiency can occur with incomplete blinking, even though meibomian gland structures are intact. This case highlights the importance of complete blinking.
authors.affiliation: MGD Clinic, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan. motoko-k@a3.keio.jp
authors.forename: Motoko
authors.initials: M
authors.lastname: Kawashima
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
mesh_terms: D000328:Adult; D001767:Blinking / Q000502:physiology*; D015352:Dry Eye Syndromes / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008055:Lipids / Q000032:analysis* / Q000172:deficiency; D013666:Tears / Q000378:metabolism*
chemical_list: D008055:Lipids