From Paper to Clinic, Episode 8: Dynamic muscle stimulation and the blink physiology behind dry eye

Welcome to From Paper to Clinic, a podcast focused on evidence-based eye care and real-world clinical decision-making, hosted by Hamza Shah, OD, MS, FAAO, a faculty member at the University of Houston College of Optometry. His work spans clinical patient care, education, and mentoring, and his clinical interests include ocular disease, dry eye, perioperative care, and, above all, the challenge of translating information into meaningful patient outcomes.

In Episode 8 of From Paper to Clinic, "Dynamic Muscle Stimulation and the Blink Physiology Behind Dry Eye," Cory Lappin, OD, MS, FAAO, of The Dry Eye Center of Ohio, joins the show to unpack a paper examining dynamic muscle stimulation of the periorbital area (DMST) as a treatment for dry eye disease. The conversation centers on an underappreciated driver of dry eye—lower lid laxity and impaired blink mechanics—and how a non-surgical device-based approach can restore normal blink function.

For decades, lower lid laxity has been treated as a surgical problem: a mechanical defect addressed only with horizontal lid-tightening procedures. The paper anchoring this episode challenges that framing by targeting the muscle of Riolan and the orbicularis oculi directly, using dynamic electrical muscle stimulation to retrain the lid's contractile function rather than surgically shortening it. The result is a treatment aimed at the root cause of an incomplete or poorly apposed blink—rather than only its downstream tear-film consequences.

The study enrolled 30 subjects with dry eye disease and measured outcomes after a series of DMST treatments delivered via a periorbital electrical stimulation device. The results were substantial: lower lid distraction test (LLDT) findings normalized from 100% of subjects showing lid laxity at baseline down to 23% post-treatment, tear breakup time (TBUT) improved by 286%, modified meibomian gland score (mMGS) improved by 78%, and Ocular Surface Disease Index (OSDI) scores dropped by 53%. No adverse events were reported.

Clinically, the implications extend beyond a single device. The conversation situates DMST alongside other in-office dry eye modalities—radiofrequency treatment and intense pulsed light therapy—as tools that address different mechanistic layers of dry eye disease: meibomian gland function, ocular surface inflammation, and now, blink mechanics and lid apposition. For practices already offering procedural dry eye care, DMST represents a non-surgical option for patients whose lid laxity previously would have prompted only a referral for blepharoplasty or lid-tightening surgery—expanding what can be managed conservatively, in-office, before surgical referral becomes necessary.

The paper inspiring this discussion is the "Dynamic Muscle Stimulation of the Periorbital Area for Improvement of Blinking in Dry Eye Patients" by James G. Chelnis and Alexandra Chelnis, published in Clinical Ophthalmology.

Do you want to only listen to this episode? Check out the audio player below.

Episode 9 is coming on Monday, November 2, 2026, at 8 AM ET

The next episode of From Paper to Clinic will debut in the first week of November and will feature Melissa Barnett, OD, FAAO, FSLS, focusing on burnout within optometry. Listeners are invited to join the conversation as the series explores how evidence moves… from paper to clinic.