Blinking Exercise Study

April 28, 2026 updated by: Enitan Sogbesan, St. Joseph's Healthcare Hamilton

Optimizing Blinking Exercises to Improve Dry Eye Disease in Patients With Glaucoma

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.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Dry eye disease (DED) is a chronic, multifactorial disorder of the ocular surface characterized by tear film instability, inflammation, and ocular discomfort. The prevalence of DED is significantly higher in patients with glaucoma, largely due to long-term use of topical intraocular pressure-lowering medications. Many of these medications contain preservatives, such as benzalkonium chloride, which are associated with ocular surface toxicity, tear film disruption, and inflammation. As a result, glaucoma patients frequently experience worsening dry eye symptoms, reduced quality of life, and decreased adherence to prescribed therapy, potentially compromising disease control and increasing the risk of vision loss.

In addition to pharmacologic factors, behavioral contributors such as reduced or incomplete blinking play an important role in the development and progression of DED. Inadequate blinking impairs tear film distribution, reduces lipid layer replenishment, and increases tear evaporation. These effects are particularly pronounced during prolonged visual tasks such as screen use. Despite the known importance of blink dynamics in ocular surface health, current management strategies for DED in glaucoma patients primarily focus on pharmacological or surgical approaches, with limited attention to modifiable behavioral interventions.

Blinking exercises have emerged as a promising non-pharmacological strategy to improve tear film stability and ocular surface function. Prior studies in non-glaucoma populations have demonstrated that structured blinking exercises can improve tear film parameters, meibomian gland function, and subjective comfort. However, there is limited evidence evaluating the effectiveness of such interventions in glaucoma patients, who represent a high-risk population due to chronic medication exposure.

This study is a prospective, controlled interventional trial designed to evaluate the effect of a structured blinking exercise on both subjective symptoms and objective signs of DED in adults with glaucoma. The intervention group will include patients with a confirmed diagnosis of glaucoma who are currently using at least one topical intraocular pressure-lowering medication. The control group will consist of glaucoma suspects who are not receiving topical therapy. Allocation to groups is based on clinical status and is not randomized.

Participants in both groups will be instructed in a standardized blinking exercise protocol consisting of 15 cycles of close-squeeze-open blinking, performed three times daily for a period of two weeks. Instruction will be provided through in-person demonstration and written materials, and participants will be encouraged to use reminders or tracking tools to support adherence.

Participants will attend three study visits: baseline, 2 weeks (post-intervention), and 4 weeks (follow-up). At each visit, validated subjective and objective assessments of dry eye will be performed. Primary outcome measures include the Ocular Surface Disease Index (OSDI), the Symptom Assessment in Dry Eye (SANDE), a blink-related comfort test, and non-invasive tear break-up time (NITBUT). Secondary outcomes include blink rate and completeness assessed through video analysis, meibomian gland function, adherence to the blinking exercise, and participant-reported acceptability.

The study aims to determine whether a brief, low-cost behavioral intervention can improve ocular surface health and reduce symptoms of DED in glaucoma patients. By targeting a modifiable behavioral factor, this intervention has the potential to complement existing glaucoma management strategies, improve patient comfort, and support adherence to long-term therapy. Findings from this pilot study will provide preliminary evidence to inform the design of larger randomized controlled trials and may contribute to the integration of behavioral interventions into comprehensive glaucoma care.

Study Type

Interventional

Enrollment (Estimated)

45

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • 18 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.

Exclusion Criteria:

• 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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Arm 1: Glaucoma Patients on Topical Therapy + Blink Training (Intervention Arm)

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
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.
No Intervention: Arm 2: Glaucoma Suspects + Blink Training (Control/Comparator Arm)

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

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Symptom Assessment in Dry Eye (SANDE):
Time Frame: 2 and 4 weeks post intervention
Measures frequency and intensity of dry eye symptoms
2 and 4 weeks post intervention
Ocular Surface Disease Index (OSDI):
Time Frame: two weeks and four weeks after the intervention
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):
Time Frame: 2 and 4 weeks post intervention
Evaluates subjective relief following blinking.
2 and 4 weeks post intervention
Non-invasive tear break-up time (NITBUT):
Time Frame: 2 and 4 weeks post intervention
Objective measure of tear film stability.
2 and 4 weeks post intervention

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Blink rate and completeness:
Time Frame: 2 and 4 weeks post intervention
Assessed using high-frame-rate video recordings.
2 and 4 weeks post intervention
Meibomian gland expressibility:
Time Frame: 2 and 4 weeks post intervention
Evaluates gland function through manual expression.
2 and 4 weeks post intervention
Adherence to the blinking exercise:
Time Frame: 2 weeks post intervention
Tracked via self-report logs or mobile reminders
2 weeks post intervention
Participant acceptability:
Time Frame: 2 weeks post intervention
Assessed through follow-up interviews.
2 weeks post intervention

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

St. Joseph's Healthcare Hamilton

Investigators

  • Principal Investigator: Enitan A. Sogbesan, M.D., McMaster University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

August 1, 2026

Primary Completion (Estimated)

March 1, 2027

Study Completion (Estimated)

March 1, 2027

Study Registration Dates

First Submitted

April 21, 2026

First Submitted That Met QC Criteria

April 21, 2026

First Posted (Actual)

April 28, 2026

Study Record Updates

Last Update Posted (Actual)

May 4, 2026

Last Update Submitted That Met QC Criteria

April 28, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 19515

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

IPD from this study will not be made publicly available due to the small sample size and single-center design, which may increase the risk of participant re-identification despite de-identification procedures. Additionally, data are collected under institutional ethics approval with restrictions on data sharing beyond the study team. However, aggregated results and summary findings will be disseminated through peer-reviewed publications and presentations to support transparency and scientific contribution

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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