Blinking Exercise Study

NCT07554937 | Not Yet Recruiting

• 1 other identifier: 19515
• Study Type: interventional
• Target: 45
• Locations: 0 countries
• Sites: N/A

Brief Summary

The goal of this clinical trial is to evaluate whether a structured blinking exercise can improve symptoms and signs of dry eye disease (DED) in adults with glaucoma who are using topical intraocular pressure-lowering medications. The study will also assess the effects of the intervention on tear film stability, blink function, and participant adherence to the exercise. The main questions this study aims to answer are: Does a two-week structured blinking exercise reduce dry eye symptoms, as measured by the Ocular Surface Disease Index (OSDI) and Symptom Assessment in Dry Eye (SANDE) questionnaires? Does the blinking exercise improve objective measures of ocular surface health, including non-invasive tear break-up time (NITBUT) and blink dynamics? Researchers will compare glaucoma patients receiving topical medications (intervention group) with glaucoma suspects not using topical therapy (control group) to evaluate the effectiveness of the blinking exercise on dry eye outcomes. Participants in both groups will receive instruction on a standardized blinking exercise protocol consisting of repeated close-squeeze-open blinking cycles performed three times daily for two weeks. Participants will attend study visits at baseline, 2 weeks (post-intervention), and 4 weeks (follow-up). At each visit, participants will complete validated dry eye questionnaires and undergo non-invasive assessments of tear film stability, blink characteristics, and meibomian gland function. Adherence to the blinking exercise will be monitored using self-reported logs or reminders.

Conditions

Dry Eye Disease (DED); Glaucoma

Keywords

Dry Eye Disease; Ocular Surface Disease; Glaucoma; Blinking Exercise; Behavioral Intervention; Medication Adherence

Outcome Measures

Primary Outcomes (4)

• Symptom Assessment in Dry Eye (SANDE):

  Measures frequency and intensity of dry eye symptoms

  2 and 4 weeks post intervention

• Ocular Surface Disease Index (OSDI):

  Assesses severity of dry eye symptoms and their impact on daily activities.

  two weeks and four weeks after the intervention

• Blink test (ocular comfort after a blink):

  Evaluates subjective relief following blinking.

  2 and 4 weeks post intervention

• Non-invasive tear break-up time (NITBUT):

  Objective measure of tear film stability.

  2 and 4 weeks post intervention

Secondary Outcomes (4)

• Blink rate and completeness:

  2 and 4 weeks post intervention

• Meibomian gland expressibility:

  2 and 4 weeks post intervention

• Adherence to the blinking exercise:

  2 weeks post intervention

• Participant acceptability:

  2 weeks post intervention

Study Arms (2)

Arm 1: Glaucoma Patients on Topical Therapy + Blink Training (Intervention Arm)

EXPERIMENTAL

Participants in this arm are patients with a confirmed diagnosis of glaucoma who are currently using at least one topical intraocular pressure-lowering medication. In addition to continuing their prescribed glaucoma therapy without modification, participants will undergo a structured blink training program. Interventions: Intervention Name: Structured Blink Training Exercise Type: Behavioral Intervention Description: Participants will perform a standardized blinking exercise consisting of 15 cycles of a close-squeeze-open eyelid sequence, completed three times daily (morning, afternoon, evening) for a duration of 2 weeks. Instruction will be provided in-person with written guidance, and participants will be encouraged to use a mirror or smartphone for technique feedback. Adherence will be monitored using daily logs and optional reminder prompts.

Behavioral: Structured Blinking Exercise Training

Arm 2: Glaucoma Suspects + Blink Training (Control/Comparator Arm)

NO INTERVENTION

Participants in this arm are glaucoma suspects who are not yet receiving topical intraocular pressure-lowering therapy. Participants will not receive pharmacologic glaucoma treatment during the study but will perform the same structured blink training protocol as the intervention group. Interventions: Intervention Name: Structured Blink Training Exercise Type: Behavioral Intervention Description: Identical blink training protocol as Arm 1 (15 cycles of close-squeeze-open blinking, three times daily for 2 weeks). Instruction, adherence monitoring, and reminders will be the same as in the intervention arm. Background Treatment (Standard Monitoring): Routine clinical observation for glaucoma suspects, including intraocular pressure monitoring as per standard care, without initiation of topical therapy during the study period. Intervention Summary Across Arms This study evaluates the effect of a structured blink training regimen on dry eye disease outcomes in two clinically distinct po

Interventions

Structured Blinking Exercise Training BEHAVIORAL

A standardized, non-drug blink exercise program where participants perform 15 close-squeeze-open blink cycles, three times daily for two weeks. It is designed specifically for glaucoma patients with dry eye, focuses on improving blink mechanics and tear film stability, includes guided instruction and adherence support, and is used alongside existing glaucoma treatment without modifying medications.

Arm 1: Glaucoma Patients on Topical Therapy + Blink Training (Intervention Arm)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• years of age or older.
• Those in the intervention group must have a confirmed diagnosis of glaucoma and be using at least one topical antiglaucoma medication.
• Control participants must be glaucoma suspects who have not yet commenced topical therapy.

You may not qualify if:

• Glaucoma patients who have had ocular surgery within the previous six months, contact lens wear, systemic inflammatory or autoimmune diseases affecting the ocular surface, or other ocular surface disorders such as severe blepharitis or keratoconjunctivitis sicca.

Sponsors & Collaborators

• St. Joseph's Healthcare Hamilton: lead

Related Publications (12)

• Wolffsohn JS, Trave-Huarte S, Bahra I, Finch C, Anyaegbu U, Garcia-Porta N, Kingsnorth A. Optimisation of blinking exercises for dry eye disease. Cont Lens Anterior Eye. 2025 Oct;48(5):102453. doi: 10.1016/j.clae.2025.102453. Epub 2025 Jun 3.

  PMID: 40467388 RESULT

• Tsubota K, Nakamori K. Dry eyes and video display terminals. N Engl J Med. 1993 Feb 25;328(8):584. doi: 10.1056/NEJM199302253280817. No abstract available.

  PMID: 8426634 RESULT

• Ruiz-Lozano RE, Azar NS, Mousa HM, Quiroga-Garza ME, Komai S, Wheelock-Gutierrez L, Cartes C, Perez VL. Ocular surface disease: a known yet overlooked side effect of topical glaucoma therapy. Front Toxicol. 2023 Jul 21;5:1067942. doi: 10.3389/ftox.2023.1067942. eCollection 2023.

  PMID: 37547228 RESULT

• Nijm LM, De Benito-Llopis L, Rossi GC, Vajaranant TS, Coroneo MT. Understanding the Dual Dilemma of Dry Eye and Glaucoma: An International Review. Asia Pac J Ophthalmol (Phila). 2020 Dec;9(6):481-490. doi: 10.1097/APO.0000000000000327.

  PMID: 33323704 RESULT

• McMonnies CW. The clinical and experimental significance of blinking behavior. J Optom. 2020 Apr-Jun;13(2):74-80. doi: 10.1016/j.optom.2019.09.002. Epub 2020 Jan 25.

  PMID: 31992536 RESULT

• Katz G, Springs CL, Craven ER, Montecchi-Palmer M. Ocular surface disease in patients with glaucoma or ocular hypertension treated with either BAK-preserved latanoprost or BAK-free travoprost. Clin Ophthalmol. 2010 Nov 3;4:1253-61. doi: 10.2147/OPTH.S14113.

  PMID: 21151330 RESULT

• Hashemi H, Khabazkhoob M, Kheirkhah A, Emamian MH, Mehravaran S, Shariati M, Fotouhi A. Prevalence of dry eye syndrome in an adult population. Clin Exp Ophthalmol. 2014 Apr;42(3):242-8. doi: 10.1111/ceo.12183. Epub 2013 Sep 13.

  PMID: 23927383 RESULT

• Guedes G, Tsai JC, Loewen NA. Glaucoma and aging. Curr Aging Sci. 2011 Jul;4(2):110-7. doi: 10.2174/1874609811104020110.

  PMID: 21235491 RESULT

• Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ, Tsubota K, Stapleton F. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017 Jul;15(3):276-283. doi: 10.1016/j.jtos.2017.05.008. Epub 2017 Jul 20.

  PMID: 28736335 RESULT

• Chamard C, Larrieu S, Baudouin C, Bron A, Villain M, Daien V. Preservative-free versus preserved glaucoma eye drops and occurrence of glaucoma surgery. A retrospective study based on the French national health insurance information system, 2008-2016. Acta Ophthalmol. 2020 Nov;98(7):e876-e881. doi: 10.1111/aos.14410. Epub 2020 Mar 31.

  PMID: 32232968 RESULT

• Baudouin C, Labbe A, Liang H, Pauly A, Brignole-Baudouin F. Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res. 2010 Jul;29(4):312-34. doi: 10.1016/j.preteyeres.2010.03.001. Epub 2010 Mar 17.

  PMID: 20302969 RESULT

• Arita R, Fukuoka S, Matsumoto R, Kaido M. Effects of blinking exercises on palpebral fissure height and tear film parameters. Ocul Surf. 2025 Apr;36:237-243. doi: 10.1016/j.jtos.2025.02.003. Epub 2025 Feb 5.

  PMID: 39920919 RESULT

MeSH Terms

Conditions

Dry Eye Syndromes; Glaucoma; Medication Adherence

Condition Hierarchy (Ancestors)

Lacrimal Apparatus Diseases; Eye Diseases; Ocular Hypertension; Patient Compliance; Patient Acceptance of Health Care; Treatment Adherence and Compliance; Health Behavior; Behavior

Study Officials

• Enitan A. Sogbesan, M.D.

  McMaster University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Ladun O. Odediran, MSc.

CONTACT

1-905-573-7777; odedirao@mcmaster.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor of Ophthalmology

Model Details: This study uses a parallel assignment model with two groups defined by clinical status. The intervention group includes adults with glaucoma using topical medications, while the control group includes glaucoma suspects not receiving treatment. The study is non-randomized, with assignment based on diagnosis. All participants will perform a standardized blinking exercise, and outcomes will be compared between groups to evaluate its effect on dry eye disease symptoms and ocular surface measures. Assessments will be conducted at baseline, 2 weeks (post-intervention), and 4 weeks (follow-up) to evaluate short-term effects and durability.

Study Record Dates

• First Submitted: April 21, 2026
• First Posted: April 28, 2026
• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): March 1, 2027
• Last Updated: May 4, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share