title: The Effects of Increasing Ocular Surface Stimulation on Blinking and Tear Secretion.
abstract: OBJECTIVE
  To investigate the effect of varying levels of ocular surface stimulation on the timing and amplitude of the blink and tear secretion.
  
  
  METHODS
  Following instillation of fluorescein dye, increasing levels of air flow were directed toward the central corneas of 10 healthy subjects. Interblink interval (IBI), tear meniscus height (TMH), and fluorescence intensity were measured simultaneously. Because blinking can obscure changes in TMH, we developed novel measures of tear secretion by calculating tear meniscus fluorescein concentration (TMFC) from intensity using a mathematical model. The change of TMH and TMFC over trials and the slope of the TMFC within each IBI (IBI-TTR) were further calculated.
  
  
  RESULTS
  The mean IBI was decreased by 8.08 ± 8.54 seconds from baseline to maximum air stimulation. The TMH increase was highly variable (0.41 ± 0.39 mm) among subjects, compared to the fluorescence tear turnover metrics: decrease in TMFC of 2.84 ± 0.98 natural logarithm or ln(%) and IBI-TTR of 0.065 ± 0.032 ln(%)/sec. Ocular surface stimulation was highly correlated with the TMFC and IBI-TTR, but less so with TMH (Pearson's r = 0.71, 0.69, and 0.40, P < 0.01, respectively). Blinking and tearing were significantly correlated with each other (Pearson's r = 0.56, P < 0.01), but tearing lagged behind by an average of 6.54 ± 4.07 seconds.
  
  
  CONCLUSIONS
  Blinking and tearing share a common origin with sensory stimulation at the ocular surface. Both showed a dose-response increase with surface stimulation and were correlated with each other. These methods can potentially be used to understand alterations in ocular surface sensory function and associated protective responses in dry eye and other disorders of the ocular surface.
authors.affiliation: School of Optometry Indiana University, Bloomington, Indiana, United States.
authors.forename: Ziwei
authors.initials: Z
authors.lastname: Wu
authors.affiliation: School of Optometry Indiana University, Bloomington, Indiana, United States.
authors.forename: Carolyn G
authors.initials: CG
authors.lastname: Begley
authors.affiliation: School of Optometry Indiana University, Bloomington, Indiana, United States.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Port
authors.affiliation: School of Optometry Indiana University, Bloomington, Indiana, United States.
authors.forename: Arthur
authors.initials: A
authors.lastname: Bradley
authors.affiliation: Department of Mathematical Sciences, University of Delaware, Newark, Delaware, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: Braun
authors.affiliation: College of Optometry, The Ohio State University, Columbus, Ohio, United States.
authors.forename: Ewen
authors.initials: E
authors.lastname: King-Smith
mesh_terms: D000328:Adult; D000388:Air; D001767:Blinking; D003315:Cornea / Q000502:physiology*; D015352:Dry Eye Syndromes / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D019793:Fluorescein / Q000032:analysis; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D010812:Physical Stimulation / Q000379:methods*; D012677:Sensation / Q000528:radiation effects*; D013666:Tears / Q000737:chemistry / Q000378:metabolism*; D055815:Young Adult
chemical_list: D019793:Fluorescein