Videographic evaluation of blinking patterns and their association with dry eye

PURPOSE: To investigate the association between spontaneous blinking patterns and dry eye disease (DED) severity. METHODS: In this single-center, cross-sectional study, patients attending cataract, general ophthalmology, and DED clinics were categorized by Ocular Surface Disease Index (OSDI) score as having no, mild, moderate, or severe DED. Spontaneous blinking was recorded using a high-speed smartphone camera and blindly analyzed by a senior oculoplastic surgeon for brow lift, blepharospasm, imbrication, lagophthalmos, eyelid margin rotation, retraction, lid separation delay, lash ptosis, dermatochalasis, and increased tear lake. DED was assessed using OSDI, tear break-up time (TBUT), Schirmer's test, and fluorescein and lissamine-green staining. Only the right eye was included. CONCLUSION: Moderate-to-severe DED was associated with a higher frequency of eyelid margin rotation during blinking. Larger studies are warranted to confirm these findings and explore potential eyelid-targeted therapeutic approaches.