Blinking and Tear Break-Up During Four Visual Tasks

Himebaugh, Nikole; Begley, Carolyn G.; Bradley, Arthur; Wilkinson, Jenni

doi:10.1097/opx.0b013e318194e962

Cited by 206 publications

(183 citation statements)

References 37 publications

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“…15 We and others have shown that dry eye patients often repeatedly display TBU during tasks such as computer use, during which the blink rate is known to slow markedly. 45,46 Thus, in patients with extensive and rapidly developing TBU (as in subjects 3 and 4), it appears likely that inadequate blinking could lead to discomfort and repeated stimulation of surface nociceptors over the day. This may explain, in part, the origin of dry eye symptoms because repeated nociceptor stimulation is associated with increased inflammation and hyperalgesia.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Tear Film Fluorescence and Discomfort During Tear Film Instability and Thinning

Begley

Simpson

Liu

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. The purpose of this study was to test the association between tear film fluorescence changes during tear break-up (TBU) or thinning and the concurrent ocular sensory response.METHODS. Sixteen subjects kept one eye open as long as possible (MBI), indicated their discomfort level continuously, and rated ocular sensations of irritation, stinging, burning, pricking, and cooling using visual analog scales (VAS). Fluorescence of the tear film was quantified by a pixel-based analysis of the median pixel intensity (PI), TBU, and percentage of dark pixels (DarkPix) over time. A cutoff of 5% TBU was used to divide subjects into either break-up (BU) or minimal break-up (BUmin) groups. RESULTS.Tear film fluorescence decreased (median PI) and the percentage of TBU and DarkPix increased in all trials, with the rate significantly greater in the BU than the BUmin group (Mann-Whitney U test, P < 0.05). The rate of increasing discomfort during trials was highly correlated with the rate of decrease in median PI and developing TBU (Spearman's, r ‡ 0.70). Significant correlations were found between corneal fluorescence, MBI, and sensory measures.CONCLUSIONS. Concentration quenching of fluorescein dye with tear film thinning best explains decreasing tear film fluorescence during trials. This was highly correlated with increasing ocular discomfort, suggesting that both tear film thinning and TBU stimulate underlying corneal nerves, although TBU produced more rapid stimulation. Slow increases in tear film hyperosmolarity may cause the gradual increase in discomfort during slow tear film thinning, whereas the sharp increases in discomfort during TBU suggest a more complex stimulus.Keywords: tear film instability, tear film break-up, tear film thinning, evaporation, fluorescein concentration quenching, corneal sensory nerves, nociception D ry eye is a common condition, affecting millions in the United States and elsewhere, 1-5 affecting quality of life, [6][7][8] and potentially engendering high health care costs now and in the future. 9 However, despite its prevalence and impact, the underlying etiology of the condition and the basis of dry eye symptoms remain subject to speculation. 10,11The recent international Dry Eye Workshop report identified the core mechanisms of dry eye as tear film hyperosmolarity and instability, which are thought to generate dry eye symptoms through repeated stress to the ocular surface, inflammation, and activation of corneal sensory nociceptors. 10In support of this hypothesis, tear hyperosmolarity has been shown to stress the surface and trigger ocular surface inflammation, 12,13 and recent reports have associated tear film hyperosmolarity with dry eye symptoms. 14 However, while tear film osmolarity is likely to fluctuate markedly or spike 15 in the interblink interval due to evaporation or other factors, [16][17][18] it cannot be measured directly over the cornea with current techniques of sampling the tears from the inferior meniscus. 19 Thus, changing conditions within the tear film during ins...

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Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Tear Film Fluorescence and Discomfort During Tear Film Instability and Thinning

Begley

Simpson

Liu

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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“…Another study in Malaysia was conducted on 795 college students aged 18-25 years. They experienced headaches along with eyestrain, with 89.9% of the students surveyed feeling any type of symptoms of CVS [2].…”

Section: Introductionmentioning

confidence: 99%

Computer Vision Syndrome: Prevalence And Predictors Among College Staff And Students

Gupta¹,

Moudgil²,

Sharma³

2016

IOSR

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“…Thus, on the one hand, increasing cognitive demands have been reported to result in a reduction in SBR, both during computer tasks [7][8][9][10][11] and other activities such as reading or watching a video story. 4,5 On the other hand, blinks tend to be associated with large gaze shifts, rather than saccades of smaller amplitude such as those involved in reading, 20,21 partially contributing to sustaining visual stability through momentary suppression of visual input, 16,17 which is particularly relevant for large gaze shifts, were saccadic suppression is less effective.…”

Section: Discussionmentioning

confidence: 99%

“…4 In addition, a similar reduction in blinking frequency with increasing task complexity has been evidenced in relation to computer use, a field in which spontaneous blinking has been extensively studied in order to understand and alleviate the symptomatology associated with the traditionally known as ''computer vision syndrome''. [7][8][9][10][11] Interestingly, from a different perspective, the increased blink rate observed in studies investigating behavioral indicators of fatigue and drowsiness has been related to a cessation of the attention-driven inhibitor of blinks.…”

Section: Q1mentioning

confidence: 99%

Blinking and Driving: the Influence of Saccades and Cognitive Workload

Cardona

Quevedo

2013

Current Eye Research

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Blinking and Tear Break-Up During Four Visual Tasks

Abstract: 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.

Cited by 206 publications

References 37 publications

Quantitative Analysis of Tear Film Fluorescence and Discomfort During Tear Film Instability and Thinning

Quantitative Analysis of Tear Film Fluorescence and Discomfort During Tear Film Instability and Thinning

Computer Vision Syndrome: Prevalence And Predictors Among College Staff And Students

Blinking and Driving: the Influence of Saccades and Cognitive Workload

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