Blink Test enhances ability to screen for dry eye disease

James S. Wolffsohn, Jennifer Patricia Craig, María Vidal Rohr, Sonia Trave Huarte, Lexia Ah Kit, Michael Wang

Research output: Contribution to journalArticlepeer-review


Aim To evaluate the patient-administered Optrex™ Dry Eye Blink Test against established clinical criteria for the diagnosis of dry eye disease (DED) and to evaluate its benefit in enhancing screening for DED. Methods Eighty-seven participants aged 38 ± 17 years, (44 female) were screened for DED using the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) diagnostic criteria. In addition to symptoms screening with the Ocular Surface Disease Index questionnaire (≥13 cut-off score for DED), these criteria required a sign of loss of homeostasis of the tear film in the form of a non-invasive tear breakup time (NIBUT) <10 s (Oculus Keratograph; K5M), an osmolarity reading ≥308 mOsm/L or an interocular difference in osmolarity of >8 (Tearlab), or ocular surface staining (>5 fluorescein corneal spots, >9 lissamine green spots or lid wiper staining [≥2 mm length & ≥25% width]) to confirm a diagnosis of DED. The self-administered Blink Test, which requires the participant to observe an image on a computer screen and report the length of time (in seconds) that they can refrain from blinking without discomfort, was repeated three times. Results Using a cut-off time of 10 s, the Blink Test demonstrated sensitivity of 66%, specificity of 88%, and an area under the curve of 0.77 (p < 0.001), in predicting a diagnosis of DED according to the TFOS DEWS II criteria. The correlation between the Blink Test and NIBUT was r = 0.47 (p < 0.001). When combined with the screening questionnaire, the sensitivity and specificity of the Blink Test increased to 71% and 90%, respectively. Conclusion The Blink Test offers health professionals without advanced instrumentation, as well as patients, themselves, a rapid method of identifying possible DED.
Original languageEnglish
Pages (from-to)421-425
Number of pages5
JournalContact Lens and Anterior Eye
Issue number5
Early online date27 Jun 2018
Publication statusPublished - 1 Oct 2018

Bibliographical note

© 2018, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International


  • Dry eye disease
  • Blink test
  • Non-invasive breakup time


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