Having had a shift in thinking myself, I have begun to screen patients for dry eye at a much younger age than I had previously.
Typically anyone over age 18 is treated as an adult in our practice. The patient completes a small dry eye questionnaire and her glands are expressed and viewed during examination.
However, because more children are using digital devices, it may become necessary to screen those patients as well. If nothing else, asking them how their eyes feel may not be a bad place to start.
As more patients are identified as having meibomian gland changes, whether in terms of structure, function or both, the question becomes what methods are available to practitioners to help those patients. Is simply reminding them to blink enough?
Blinking has a significant role in the secretion of meibum into the tear film.1 If the blink rate is slowed or blinks are incomplete, meibomian glands will be used less over time. This could lead to meibomian gland atrophy if unidentified.1
For patients who are less symptomatic but are at risk of developing a problem with their meibomian glands, I prescribe blinking exercises. Younger females are more likely to show early signs of meibomian gland atrophy than males.4
Related: How to know when it isn’t dry eye
There isn’t a set of rules for how to tell your patients to blink. I tell patients to do 10 good blinks—meaning eyes fully closed for two seconds, then squeezed for another two seconds—for every hour of digital device use.
I encourage patients to download a blinking app created by Donald S. Korb, OD, FAAO. It is available for iOS for free in the App Store. Patients can set their own blinking reminders for their desired frequency.
Typically I will encourage awareness of blinking and completion of the blinking exercises for one month, then see the patient for a brief follow-up visit. My hope is that my wanting to see them in a month’s time will help ensure compliance and, in that time frame, may also allow the patient to experience some benefit from the exercises.