The (nursery) rhyme and reason behind blinking

I have been enamored of fairy tales and nursery rhymes since childhood. Whether it’s an Aesop fable or a spontaneous rhyme, I seem to have one for every situation.

I am particularly fond of “Wynken, Blynken, and Nod,” a poem for children written by American writer Eugene Field and published in 1889.¹ This whimsical poem narrates the nocturnal journey of 3 children, Wynken, Blynken, and Nod. In a wooden shoe, they “sailed on a river of crystal light into a sea of dew,” fishing for “herring fish.” The stars, represented as fish, encourage them, and the moon sings a lullaby. As they return home in their shoe-turned-trundle-bed, the final stanza reveals that the voyage is a metaphor for a child falling asleep: Wynken and Blynken as the eyes, and Nod as the nodding head.²

As an eye care provider, especially one interested in dry eye disease, the poem tickles me. After all, evaluating the rate, fullness, and quality of a patient’s blink is a regular part of my work.

Blinking is a complex reflex involving multiple sensory inputs and neural pathways. Corneal cold thermoreceptors contribute to regulating the baseline blink rate and magnitude of the blink response in a protective capacity. TRPM8 is a tear evaporation, cold- and menthol-sensing receptor found on nerve endings of the ophthalmic branch of the trigeminal nerve.³ TRPM8-dependent activity on the cornea and eyelid margins evokes reflex blink responses. The amplitude and duration of reflex blink are proportional to corneal temperature change. During the interblink intervals, corneal temperature gradually drops slightly. This mild cooling activates cold thermoreceptor neurons and, although it does not evoke conscious sensations, it seems sufficient to trigger so-called spontaneous blinking.⁴

Of course, the eyelids and musculature of the lids must be positioned and strong enough to complete an effective blink that spreads the tear film completely across the ocular surface and guides spent tears into the lacrimal drainage system. The palpebral, orbital, and lacrimal parts of the orbicularis oculi are responsible for this graceful task. The palpebral musculature allows for gentle, involuntary blinking. The orbital muscles of the orbicularis oculi are called upon for forceful blinking or squeezing the eyelids shut. The lacrimal portion—the deepest and most medial of the 3 parts of the orbicularis oculi—is a small, thin muscle behind the lacrimal sac and medial palpebral ligament. It inserts into the wall of the lacrimal sac and helps to drain tears by drawing the eyelids medially and compressing the lacrimal sac. All 3 components must work in harmony to spread the tear film uniformly across the ocular surface and ensure efficient drainage of spent tears.

As eye care clinicians, we are practicing at a time of exponential interest in ocular surface disease, which is prompting the development of innovative treatments across therapeutic platforms. Outlined here are some treatments and techniques to offer to your patients to impact eyelid position, blink rate, and efficacy of the blink in supporting the tear system.

Blinking reminders and training

There are numerous downloadable applications with various functions and metrics to improve the efficiency of the blink. More advanced apps offer blink training and biofeedback.

Blinking exercises

Blinking exercises have long been touted by eye care practitioners to help deliver lipid from the meibomian gland and spread the tear film for improving. Recent data suggest that a battery of blinking exercises can also alter eyelid tonus, reduce incomplete blink rate, increase palpebral fissure height, and perhaps increase blood flow to the orbicularis oculi, thereby reducing eyelid edema⁵ and potentially reducing secondary scleral show.

Dynamic Muscle Stimulation technology (DMSt)

Clinical study results published in March 2025 showed that DMSt (OptiLIFT; Lumenis) restored muscle tone to improve function of the lower eyelid and blinking quality. DMSt in the periorbital area demonstrated a reduction in lid laxity by at least 75%, an improvement in blinking quality by at least 70%, and a significant 286% increase in tear breakup time.⁶

Topical neuromodulation

Acoltremon (Tryptyr; Alcon) is the first neuromodulator eye drop to demonstrate rapid improvement in natural tear output. The neuromodulator stimulates corneal sensory nerves to increase natural tear production following instillation.⁷ Intuitively, a better tear should enhance blink comfort and indirectly support better blinking patterns, although there is no study evidence. Interestingly, study results have suggested that acoltremon acts as an agonist of TRPM8 thermoreceptors, stimulating the trigeminal nerve to increase basal tear production.

Direct eyelid treatment

New to the over-the-counter market is a topically applied solution with active ingredients that include caffeine and organic Mentha arvensis leaf oil (WINQ; Tear Restore). The essential oil is extracted from the leaves of the Mentha arvensis plant, commonly known as corn mint or field mint. The oil is known for its minty aroma and is rich in menthol, the compound responsible for its signature cooling sensation.⁸ Cooling plant extracts help stimulate TRPM8 receptors, mimicking tear evaporation and restoring a more natural blink rate. Caffeine applied topically can reduce eyelid edema.⁹ For instance, positive data from Tear Restore has been documented on the efficacy of this serum on blink mechanics with improved blink rate and excursion after application.¹⁰ 

Just like Wynken, Blynken, and Nod set sail on their nightly voyage, our eyelids take us on rhythmic journeys, blinking thousands of times each day to protect, hydrate, and nurture the ocular surface. As clinicians, understanding and enhancing this seemingly simple function offers meaningful benefits to patient comfort and ocular health.

References:

1. Field E. “Wynken, Blynken, and Nod.” Poets.org. Accessed September 9, 2025. https://poets.org/poem/wynken-blynken-and-nod
2. “Wynken, Blynken, and Nod.” All Poetry. Accessed September 9, 2025. https://allpoetry.com/Wynken,-Blynken,-And-Nod
3. Fakih D, Migeon T, Moreau N, Baudouin C, Réaux-Le Goazigo A, Mélik Parsadaniantz S. Transient receptor potential channels: important players in ocular pain and dry eye disease. Pharmaceutics. 2022;14(9):1859. doi:10.3390/pharmaceutics14091859
4. Gallar J, Aleixandre-Carrera F, Aracil-Marco A, et al. TRPM8-dependent activity of corneal cold thermoreceptor neurons contributes to both reflex and spontaneous blink. Invest Ophthalmol Vis Sci. 2024;65(7):2634.
5. Arita R, Fukuoka S, Matsumoto R, Kaido M. Effects of blinking exercises on palpebral fissure height and tear film parameters. Ocul Surf. 2025;36:237-243. doi:10.1016/j.jtos.2025.02.003
6. Chelnis JG, Chelnis A. Dynamic muscle stimulation of the periorbital area for improvement of blinking in dry eye patients. Clin Ophthalmol. 2025;19:1057-1071. doi:10.2147/OPTH.S513989
7. Alcon announces FDA approval of Tryptyr (acoltremon ophthalmic solution) 0.003% for the treatment of the signs and symptoms of dry eye disease. News release. Alcon. May 28, 2025. Accessed September 9, 2025. https://www.alcon.com/media-release/alcon-announces-fda-approval-tryptyr-acoltremon-ophthalmic-solution-0003-treatment/
8. Mentha arvensis leaf oil. Commonshare. Accessed September 9, 2025. https://www.commonshare.com/materials/mentha-arvensis-leaf-oil
9. Desai SC. How to get rid of bags under your eyes. John Hopkins Medicine. Accessed September 9, 2025. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/how-to-get-rid-of-bags-under-your-eyes.
10. Delaney-Gesing A. TearRestore launches eyelid serum for digital eye strain. Eyes On Eyecare. April 21, 2025. Accessed September 15, 2025. https://glance.eyesoneyecare.com/stories/2024-05-23/tearrestore-launches-neutrawipe-eco-eyelid-cleanser/?utm_medium=eoe:infinite-scroll