Characterizing the spontaneous blink generator: an animal model

An eye on the dog as the scientist's best friend for translational research in ophthalmology: Focus on the ocular surface

Preclinical animal studies provide valuable opportunities to better understand human diseases and contribute to major advances in medicine. This review provides a comprehensive overview of ocular parameters in humans and selected animals, with a focus on the ocular surface, detailing species differences in ocular surface anatomy, physiology, tear film dynamics and tear film composition. We describe major pitfalls that tremendously limit the translational potential of traditional laboratory animals (i.e., rabbits, mice, and rats) in ophthalmic research, and highlight the benefits of integrating companion dogs with clinical analogues to human diseases into preclinical pharmacology studies. This One Health approach can help accelerate and improve the framework in which ophthalmic research is translated to the human clinic. Studies can be conducted in canine subjects with naturally occurring or noninvasively induced ocular surface disorders (e.g., dry eye disease, conjunctivitis), reviewed herein, and tear fluid can be easily retrieved from canine eyes for various bioanalytical purposes. In this review, we discuss common tear collection methods, including capillary tubes and Schirmer tear strips, and provide guidelines for tear sampling and extraction to improve the reliability of analyte quantification (drugs, proteins, others).

Substance use is associated with reduced devaluation sensitivity

Substance use has been linked to impairments in reward processing and decision-making, yet empirical research on the relationship between substance use and devaluation of reward in humans is limited. We report findings from two studies that tested whether individual differences in substance use behavior predicted reward learning strategies and devaluation sensitivity in a nonclinical sample. Participants in Experiment 1 (N = 66) and Experiment 2 (N = 91) completed subscales of the Externalizing Spectrum Inventory and then performed a two-stage reinforcement learning task that included a devaluation procedure. Spontaneous eye blink rate was used as an indirect proxy for dopamine functioning. In Experiment 1, correlational analysis revealed a negative relationship between substance use and devaluation sensitivity. In Experiment 2, regression modeling revealed that while spontaneous eyeblink rate moderated the relationship between substance use and reward learning strategies, substance use alone was related to devaluation sensitivity. These results suggest that once reward-action associations are established during reinforcement learning, substance use predicted reduced sensitivity to devaluation independently of variation in eyeblink rate. Thus, substance use is not only related to increased habit formation but also to difficulty disengaging from learned habits. Implications for the role of the dopaminergic system in habitual responding in individuals with substance use problems are discussed.

The clinical and experimental significance of blinking behavior

Evaluations of tear functions frequently involve some form of voluntary control over blink behaviour. To the degree that voluntary control of blinking risks departure from normal-range spontaneous blinking, the tear function findings from such studies may be confounded. Even subject awareness that blinking is being assessed may influence findings if such awareness results in any degree of voluntary control. Ideally, the influence on blink rate and tear functions induced by therapeutic or experimental interventions could be measured against a normal-range baseline spontaneous blink rate in order that any differences found could be validly attributed to those interventions. Sometimes pre-intervention 'rest-related' baseline blink rates have been incorrectly described as 'basal' blink rates without specification of pre-intervention conditions of 'rest' or consideration of any contributions from voluntary control. Also, studies which use only blink rates to measure blink efficiency ignore the critically important contribution of incomplete blinking to blink inefficiency. This review finds that the assessment of normal-range spontaneous blink rates depends on measurement conditions which have frequently been ignored previously. For example, normal-range spontaneous blink rates appear more likely to occur with fixation targets which have a disengaged affect and an associated neutral influence on and from dopamine activity. Ideally, fixation targets should also involve minimal cognitive loading and vision demands. In addition, normal-range (symptom free) spontaneous blink rates are more likely to be assessed in a comfortable ambient environment without subject awareness that blink behaviour is being assessed and when voluntary blinking is not involved.

Sex, blinking, and dry eye

Blinking sustains the corneal tear film generated by sexually dimorphic lacrimal and meibomian glands. Our study examines whether trigeminal control of blinking is also sexually dimorphic by investigating trigeminal reflex blinking, associative blink modification, and spontaneous blinking in male and female rats before and after unilateral dry eye caused by exorbital gland removal. Before gland removal, female rats exhibited a lower threshold for evoking trigeminal reflex blinks, a weaker effect of associative blink modification, and longer-duration spontaneous blinks than males. Spontaneous blink rate, reflex blink excitability, and occurrence of blink oscillations did not differ between the sexes. Reanalysis of previous data showed that humans showed the same blink sexual dimorphisms as rats. During the first 2 wk of dry eye, trigeminal blink circuit excitability and blink oscillations steadily rose in male rats, whereas excitability and blink oscillations did not change in females. Following dry eye, spontaneous blink duration increased for both males and females, whereas spontaneous blink rate remained constant for males but decreased for females. The associative modification treatment to depress trigeminal blink amplitude initially produced blink depression in males that converted to blink potentiation as trigeminal excitability rose, whereas females exhibited progressively more blink depression. These data indicated that dry eye increased excitability in male trigeminal reflex blink circuits at the expense of circuit modifiability, whereas trigeminal modifiability increased in females. This increased modifiability of female trigeminal blink circuits with dry eye may contribute to the preponderance of females developing the focal dystonia, benign essential blepharospasm.NEW & NOTEWORTHY All the elements controlling the corneal tear film are sexually dimorphic. Blinking, which smooths and maintains the tear film, also exhibits sex differences. Dry eye increases the sexual dimorphisms of blinking, including increased exaggeration of excitability in males and enhanced modifiability of the female trigeminal complex. This increased modifiability may explain female predominance in the development of the focal dystonia, benign essential blepharospasm.

Evaluation of Corneal Damage After Lacrimal Gland Excision in Male and Female Mice

Purpose

Lacrimal gland excision (LGE) has been utilized in several studies to model aqueous tear deficiency, yet sex as a biological variable has not been factored in to these reports. This study compared corneal pathology in male and female mice following LGE-induced dry eye.

Methods

An LGE of either the extraorbital lacrimal gland (single LGE) or both the extraorbital and intraorbital lacrimal glands (double LGE) was performed in male and female C57BL/6J and Balb/cJ mice to produce dry eye of graded severity. Following excision, tearing was evaluated with phenol red thread, and corneal fluorescein staining was scored to quantify the severity of damage. Corneas were evaluated for apoptosis by the TUNEL assay and for cell proliferation using Ki67 staining. Furthermore, corneas were harvested and analyzed for macrophages via flow cytometry.

Results

Baseline tearing levels were similar in male and female mice, and LGE resulted in comparable reductions in tearing with the lowest levels recorded after double LGE. As determined by fluorescein staining, LGE produced more severe damage to the cornea in female C57BL/6J and Balb/cJ mice. Double LGE increased TUNEL and Ki67 staining in the cornea, with greater increases found in female mice. Furthermore, LGE produced a greater increase in the total number of corneal macrophages in female mice.

Conclusions

These results indicate that female mice are more susceptible to LGE-induced corneal damage. The mechanisms involved in producing these sex differences still need to be elucidated but may involve increased inflammation and macrophage infiltration.

Spontaneous eye blink rate predicts individual differences in exploration and exploitation during reinforcement learning

Spontaneous eye blink rate (sEBR) has been linked to striatal dopamine function and to how individuals make value-based choices after a period of reinforcement learning (RL). While sEBR is thought to reflect how individuals learn from the negative outcomes of their choices, this idea has not been tested explicitly. This study assessed how individual differences in sEBR relate to learning by focusing on the cognitive processes that drive RL. Using Bayesian latent mixture modelling to quantify the mapping between RL behaviour and its underlying cognitive processes, we were able to differentiate low and high sEBR individuals at the level of these cognitive processes. Further inspection of these cognitive processes indicated that sEBR uniquely indexed explore-exploit tendencies during RL: lower sEBR predicted exploitative choices for high valued options, whereas higher sEBR predicted exploration of lower value options. This relationship was additionally supported by a network analysis where, notably, no link was observed between sEBR and how individuals learned from negative outcomes. Our findings challenge the notion that sEBR predicts learning from negative outcomes during RL, and suggest that sEBR predicts individual explore-exploit tendencies. These then influence value sensitivity during choices to support successful performance when facing uncertain reward.

The Effect of Mindfulness Meditation on Impulsivity and its Neurobiological Correlates in Healthy Adults

Interest has grown in using mindfulness meditation to treat conditions featuring excessive impulsivity. However, while prior studies find that mindfulness practice can improve attention, it remains unclear whether it improves other cognitive faculties whose deficiency can contribute to impulsivity. Here, an eight-week mindfulness intervention did not reduce impulsivity on the go/no-go task or Barratt Impulsiveness Scale (BIS-11), nor produce changes in neural correlates of impulsivity (i.e. frontostriatal gray matter, functional connectivity, and dopamine levels) compared to active or wait-list control groups. Separately, long-term meditators (LTMs) did not perform differently than meditation-naïve participants (MNPs) on the go/no-go task. However, LTMs self-reported lower attentional impulsivity, but higher motor and non-planning impulsivity on the BIS-11 than MNPs. LTMs had less striatal gray matter, greater cortico-striatal-thalamic functional connectivity, and lower spontaneous eye-blink rate (a physiological dopamine indicator) than MNPs. LTM total lifetime practice hours (TLPH) did not significantly relate to impulsivity or neurobiological metrics. Findings suggest that neither short- nor long-term mindfulness practice may be effective for redressing impulsive behavior derived from inhibitory motor control or planning capacity deficits in healthy adults. Given the absence of TLPH relationships to impulsivity or neurobiological metrics, differences between LTMs and MNPs may be attributable to pre-existing differences.

Attentional blink and putative noninvasive dopamine markers: Two experiments to consolidate possible associations

Adaptive behavioral control involves a balance between top-down persistence and flexible updating of goals under changing demands. According to the metacontrol state model (MSM), this balance emerges from the interaction between the frontal and the striatal dopaminergic system. The attentional blink (AB) task has been argued to tap into the interaction between persistence and flexibility, as it reflects overpersistence—the too-exclusive allocation of attentional resources to the processing of the first of two consecutive targets. Notably, previous studies are inconclusive about the association between the AB and noninvasive proxies of dopamine including the spontaneous eye blink rate (sEBR), which allegedly assesses striatal dopamine levels. We aimed to substantiate and extend previous attempts to predict individual sizes of the AB in two separate experiments with larger sample sizes (N = 71 & N = 65) by means of noninvasive behavioral and physiological proxies of dopamine (DA), such as sEBR and mood measures, which are likely to reflect striatal dopamine levels, and color discrimination, which has been argued to tap into the frontal dopamine levels. Our findings did not confirm the prediction that AB size covaries with sEBR, mood, or color discrimination. The implications of this inconsistency with previous observations are discussed.

Twitches, Blinks, and Fidgets: Important Generators of Ongoing Neural Activity

Animals and humans continuously engage in small, spontaneous motor actions, such as blinking, whisking, and postural adjustments ("fidgeting"). These movements are accompanied by changes in neural activity in sensory and motor regions of the brain. The frequency of these motions varies in time, is affected by sensory stimuli, arousal levels, and pathology. These fidgeting behaviors can be entrained by sensory stimuli. Fidgeting behaviors will cause distributed, bilateral functional activation in the 0.01 to 0.1 Hz frequency range that will show up in functional magnetic resonance imaging and wide-field calcium neuroimaging studies, and will contribute to the observed functional connectivity among brain regions. However, despite the large potential of these behaviors to drive brain-wide activity, these fidget-like behaviors are rarely monitored. We argue that studies of spontaneous and evoked brain dynamics in awake animals and humans should closely monitor these fidgeting behaviors. Differences in these fidgeting behaviors due to arousal or pathology will "contaminate" ongoing neural activity, and lead to apparent differences in functional connectivity. Monitoring and accounting for the brain-wide activations by these behaviors is essential during experiments to differentiate fidget-driven activity from internally driven neural dynamics.

Objective assessment of blinking and facial expressions in Parkinson's disease using a vertical electro-oculogram and facial surface electromyography

OBJECTIVE

Hypomimia is a common and early symptom of Parkinson's disease (PD), which reduces the ability of PD patients to manifest emotions. Currently, it is visually evaluated by the neurologist during neurological examinations for PD diagnosis, as described in task 3.2 of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Since such an evaluation is semi-quantitative and affected by inter-variability, this paper aims to measure the physiological parameters related to eye blink and facial expressions extracted from a vertical electro-oculogram (VEOG) and facial surface electromyography (fsEMG) to differentiate PD patients from healthy control subjects (HCs).

APPROACH

The spontaneous eye blink rate-minute (sEBR), its maximum amplitude (BMP), and facial cutaneous muscle activity were measured in 24 PD patients and 24 HCs while the subjects looked at a visual-tester composed of three main parts: static vision, dynamic vision and reading silently. Specificity and sensitivity for each parameter were calculated.

MAIN RESULTS

The VEOG and the fsEMG allowed the identification of some parameters related to eye blink and facial expressions (i.e. sEBR, BMP, frontal and peribuccal muscular activities), being able to distinguish between PD patients and HCs with high sensitivity and specificity.

SIGNIFICANCE

The demonstration that the combination of parameters related to eye blink and facial expressions can discriminate (with high accuracy) between PD patients versus HCs, thus resulting in a useful tool to support the neurologist in objective assessment of hypomimia for improving PD diagnosis.

TRPV1 and TRPM8 Channels and Nocifensive Behavior in a Rat Model for Dry Eye

Purpose

Persistent ocular surface pain occurs in moderate to severe dry eye disease (DE); however, the mechanisms that underlie this symptom remain uncertain. The aim of this study was to determine if the transient receptor potential vanilloid ion channels play a role in hypertonic saline (HS)-evoked corneal reflexes in a model for aqueous tear deficient DE.

Methods

Eye wipe behavior and orbicularis oculi muscle activity (OOemg) were measured after ocular instillation of HS, capsaicin, or menthol 14 days after exorbital gland removal. Total RNA and protein were measured from anterior eye segment and trigeminal ganglia of sham and DE rats.

Results

Eye wipe behavior was enhanced in DE rats after HS and capsaicin instillation, but not after menthol when compared to sham rats. DE rats displayed greater OOemg activity after HS and capsaicin, but not after menthol, compared to sham rats. HS-evoked OOemg activity was reduced by selective TRPV1 antagonists and by coapplication of capsaicin plus QX-314, a charged lidocaine derivative. Menthol did not affect OOemg activity; however, selective antagonism of TRPM8 reduced HS-evoked OOemg activity. TRPV1 protein levels were increased in anterior eye segment and trigeminal ganglion samples from DE rats, whereas TRPM8 levels were not affected.

Conclusions

These results suggest that TRPV1 plays a significant role in mediating enhanced nocifensive behavior in DE, while TRPM8 may play a lesser role. Strategies to target specific transducer molecules on corneal nerves may prove beneficial as adjunct therapies in managing ocular pain in moderate to severe cases of DE.

Spontaneous blink rate as an index of attention and emotion during film clips viewing

Spontaneous blinking is a non-invasive indicator known to reflect dopaminergic influence over frontal cortex and attention allocation in perceptual tasks. 38 participants watched eighteen short film clips (2 min), designed to elicit specific affective states, and arranged in six different emotional categories, while their eye movements were recorded from the vertical electroculogram. The largest blink rate inhibition, reflecting greater attention allocation to the movie, was observed during the presentation of Erotic clips, excerpts on wilderness depicting beautiful landscapes (Scenery), as well as clips showing crying characters (Compassion). Instead, the minimum blink rate inhibition was found for Fear clips, which induced a defensive response with stimulus rejection. Blink rate across time evidenced how Compassion clips elicited early inhibition while Sadness clips induced a slower, later inhibition. Correlation analyses also revealed a negative correlation (r < -0.40) between total blink rate recorded during Erotic and Compassion clips and self-reported interest. Overall, the main variable explaining blink rate was emotional Valence. Results suggest that blink modulation is related with the motivational relevance and biological significance of the stimuli, tracking their differential recruitment of attentional resources. Furthermore, they provide a solid background for studying the emotion-attention patterns and their deficits also in clinical samples (e.g., neurological and psychiatric patients) using spontaneous blinking as a not-interfering psychophysiological measure.

Writing, reading, and speaking in blepharospasm

The aim of the study was to evaluate the effects of writing, reading, and speaking on orbiculari oculi (OO) muscle spasms and on the blink rate in patients with blepharospasm (BSP). Patients with hemifacial spasm (HFS) and healthy subjects (HS) acted as control subjects. Thirty patients with BSP, 20 patients with primary HFS and 20 age-matched healthy subjects were videotaped according to a standardized procedure: at rest with eyes open; while writing a standard sentence on paper; while writing a standard sentence on a blackboard keeping the head straight; during a conversation based on a simple topic (speaking task); and while reading a standard text aloud. Two independent movement disorders specialists reviewed the videotapes and measured the number of OO spasms and blinks in each segment. Writing and reading reduced the number of OO spasms in BSP patients, whereas speaking did not. On the other hand, writing, reading, and speaking did not modify spasms in HFS patients. These tasks modulated the blink rate in all the three groups of subjects (BSP, HFS, and HS). Our hypothesis is that the modulation of OO spasm in BSP during writing and reading depends on influences coming from occipital areas onto the brainstem circuits. Whether cognitive training with reading and writing may be used to improve OO muscle spasms is an issue that warrants further investigation.

Functional and Morphologic Alterations in Mechanical, Polymodal, and Cold Sensory Nerve Fibers of the Cornea Following Photorefractive Keratectomy

Purpose

To define the characteristics and time course of the morphologic and functional changes experienced by corneal sensory nerves after photorefractive keratectomy (PRK).

Methods

Unilateral corneal excimer laser photoablation was performed in 54 anesthetized 3- to 6-month-old mice; 11 naïve animals served as control. Mice were killed 0, 3, 7, 15, and 30 days after PRK. Excised eyes were placed in a recording chamber superfused at 34°C. Electrical nerve impulse activity of single sensory terminals was recorded with a micropipette applied onto the corneal surface. Spontaneous and stimulus-evoked (cold, heat, mechanical, and chemical stimuli) nerve terminal impulse (NTI) activity was analyzed. Corneas were fixed and stained with anti-β-Tubulin III antibody to measure nerve density and number of epithelial nerve penetration points of regenerating subbasal leashes.

Results

Nerve fibers and NTI activity were absent in the injured area between 0 and 7 days after PRK, when sparse regenerating nerve sprouts appear. On day 15, subbasal nerve density reached half the control value and abnormally responding cold-sensitive terminals were recorded inside the lesion. Thirty days after PRK, nerve density was almost restored, active cold thermoreceptors were abundant, and polymodal nociceptor activity first reappeared.

Conclusions

Morphologic regeneration of subbasal corneal nerves started shortly after PRK ablation and was substantially completed 30 days later. Functional recovery appears faster in cold terminals than polymodal terminals, possibly reflecting an incomplete damage of the more extensively branched cold-sensitive axon terminals. Evolution of postsurgical discomfort sensations quality may be associated with the variable regeneration pattern of each fiber type.

Examining the link between reward and response inhibition in individuals with substance abuse tendencies

BACKGROUND

Substance use problems are often characterized by dysregulation in reward sensitivity and inhibitory control. In line with this representation, the goal of this investigation was to determine how substance abuse tendencies among university students affect incentivized response inhibition. Additionally, this study examined whether striatal dopamine moderates the impact of substance use on response inhibition performance.

METHODS

The sample included ninety-eight university students. Participants completed this prospective experimental study at an on-campus laboratory. All participants completed substance abuse and disinhibition subscales of the Externalizing Spectrum Inventory-Brief Form. Using a within-subjects design, participants then performed the Stop Signal Task under both neutral (unrewarded) and reward conditions, in which correct response cancellations resulted in a monetary reward. Striatal tonic dopamine levels were operationalized using spontaneous eyeblink rate.

RESULTS

The outcome measures were Stop Signal Reaction Time (SSRT) performance in the unrewarded and rewarded phases of the task. A hierarchical linear regression analysis, controlling for trait disinhibition, age, gender, and cigarette smoking status, identified an interactive effect of substance use and striatal dopamine levels on incentivized SSRT. Substance abuse tendencies were associated with slower SSRT and thus poorer inhibitory control under reward conditions among individuals with low levels of striatal dopamine (F = 7.613, p = .007).

CONCLUSIONS

This work has implications for research examining advanced drug use trajectories. In situations in which rewards are at stake, drug users with low tonic dopamine may be more motivated to seek those rewards at the expense of regulating inhibitory control.

Threshold-varying integrate-and-fire model reproduces distributions of spontaneous blink intervals

Spontaneous blinking is one of the most frequent human behaviours. While attentionally guided blinking may benefit human survival, the function of spontaneous frequent blinking in cognitive processes is poorly understood. To model human spontaneous blinking, we proposed a leaky integrate-and-fire model with a variable threshold which is assumed to represent physiological fluctuations during cognitive tasks. The proposed model is capable of reproducing bimodal, normal, and widespread peak-less distributions of inter-blink intervals as well as the more common popular positively skewed distributions. For bimodal distributions, the temporal positions of the two peaks depend on the baseline and the amplitude of the fluctuating threshold function. Parameters that reproduce experimentally derived bimodal distributions suggest that relatively slow oscillations (0.11–0.25 Hz) govern blink elicitations. The results also suggest that changes in blink rates would reflect fluctuations of threshold regulated by human internal states.

A potential link between gambling addiction severity and central dopamine levels: Evidence from spontaneous eye blink rates

Accumulating evidence points at similarities between substance use disorders (SUD) and gambling disorder on the behavioral and neural level. In SUD, attenuation of striatal D2/3-receptor availability is a consistent finding, at least for stimulating substances. For gambling disorder, no clear association with striatal D2/3-receptor availability has been unveiled so far. With its presumably negligible dopaminergic toxicity, possible differences in receptor availability in gambling disorder might constitute a vulnerability marker. Spontaneous eye blink rate (sEBR) is discussed as a potential proxy measure for striatal dopamine D2/3-receptor availability. Here we examined sEBR in 21 male problem gamblers and 20 healthy control participants. In addition, participants completed a screening questionnaire for overall psychopathology and self-reported measures of alcohol and nicotine consumption. We found no significant difference in sEBR between gamblers and controls. However, in gamblers, sEBR was negatively associated with gambling severity and positively associated with psychopathology. A final exploratory analysis revealed that healthy controls with low sEBR displayed higher alcohol and nicotine consumption than healthy participants with high sEBR. Although the exact association between dopamine transmission and sEBR is still debated, our findings reveal that sEBR is sensitive to inter-individual differences in gambling disorder severity in problem gamblers.

Acute hyperalgesia and delayed dry eye after corneal abrasion injury

Introduction:

Corneal nerves mediate pain from the ocular surface, lacrimation, and blinking, all of which protect corneal surface homeostasis and help preserve vision. Because pain, lacrimation and blinking are rarely assessed at the same time, it is not known whether these responses and their underlying mechanisms have similar temporal dynamics after acute corneal injury.

Methods:

We examined changes in corneal nerve density, evoked and spontaneous pain, and ocular homeostasis in Sprague-Dawley male rats after a superficial epithelial injury with heptanol. We also measured changes in calcitonin gene-related peptide (CGRP), which has been implicated in both pain and epithelial repair.

Results:

Hyperalgesia was seen 24 hours after abrasion injury, while basal tear production was normal. One week after abrasion injury, pain responses had returned to baseline levels and dry eye symptoms emerged. There was no correlation between epithelial nerve density and pain responses. Expression of both ATF3 (a nerve injury marker) and CGRP increased in trigeminal ganglia 24 hours after injury when hyperalgesia was seen, and returned to normal one week later when pain behavior was normal. These molecular changes were absent in the contralateral ganglion, despite reductions in corneal epithelial nerve density in the uninjured eye. By contrast, CGRP was upregulated in peripheral corneal endings 1 week after injury, when dry eye symptoms emerged.

Conclusion:

Our results demonstrate dynamic trafficking of CGRP within trigeminal sensory nerves following corneal injury, with elevations in the ganglion correlated with pain behaviors and elevations in peripheral endings correlated with dry eye symptoms.

Differentiating positive schizotypy and mania risk scales and their associations with spontaneous eye blink rate

Positive schizotypy and mania risk scales are strongly correlated, and both are linked to alterations in striatal dopamine. Previous research has not examined whether these risk scales form distinct factors or whether they are differentially related to other measures of psychopathology risk or striatal dopamine. In the current study (N = 596), undergraduate students completed both positive schizotypy and mania risk scales as well as scales assessing related psychopathology (i.e., negative and disorganized schizotypy; self-reported manic-like episodes). Additionally, we measured spontaneous eye blink rate, which has been consistently associated with striatal dopamine levels. Positive schizotypy and mania risk factors were strongly correlated (factor correlation = 0.73). However, a two-factor model with positive schizotypy and mania risk as separate factors fit significantly better than a one-factor risk model. After removing shared variance, only positive schizotypy was positively associated with both negative and disorganized schizotypy, and only mania risk was related to self-reported manic-like episodes. Furthermore, positive schizotypy was associated with decreased spontaneous eye blink rate, and mania risk was associated with increased spontaneous eye blink rate. Overall, these results suggest that positive schizotypy and mania risk can be distinguished as separate factors and that they might be differentially associated with striatal dopamine measures.

Humans quickly learn to blink strategically in response to environmental task demands

Eye blinking is one of the most frequent human actions. The control of blinking is thought to reflect complex interactions between maintaining clear and healthy vision and influences tied to central dopaminergic functions including cognitive states, psychological factors, and medical conditions. The most imminent consequence of blinking is a temporary loss of vision. Minimizing this loss of information is a prominent explanation for changes in blink rates and temporarily suppressed blinks, but quantifying this loss is difficult, as environmental regularities are usually complex and unknown. Here we used a controlled detection experiment with parametrically generated event statistics to investigate human blinking control. Subjects were able to learn environmental regularities and adapted their blinking behavior strategically to better detect future events. Crucially, our design enabled us to develop a computational model that allows quantifying the consequence of blinking in terms of task performance. The model formalizes ideas from active perception by describing blinking in terms of optimal control in trading off intrinsic costs for blink suppression with task-related costs for missing an event under perceptual uncertainty. Remarkably, this model not only is sufficient to reproduce key characteristics of the observed blinking behavior such as blink suppression and blink compensation but also predicts without further assumptions the well-known and diverse distributions of time intervals between blinks, for which an explanation has long been elusive.

Blink: Characteristics, Controls, and Relation to Dry Eyes

Blink is a complex phenomenon that is profoundly affected by diverse endogenous and exogenous stimuli. It has been studied in the context of cognition, emotional, and psychological states, as an indicator of fatigue and sleepiness, particularly in the automobile and transportation industry, in visual tasking, and finally, as it relates to tear film stability and ocular surface health. The fact that it is highly variable and has input from so many sources makes it very difficult to study. In the present review, the behavior of blink in many of these systems is discussed, ultimately returning in each instance to a discussion of how these factors affect blink in the context of dry eyes. Blink is important to ocular surface health and to an individual's optimal functioning and quality of life. Disturbances in blink, as cause or effect, result in a breakdown of tear film stability, optical clarity, and visual function.

Individual differences in eye blink rate predict both transient and tonic pupil responses during reversal learning

The pupil response under constant illumination can be used as a marker of cognitive processes. In the past, pupillary responses have been studied in the context of arousal and decision-making. However, recent work involving Parkinson's patients suggested that pupillary responses are additionally affected by reward sensitivity. Here, we build on these findings by examining how pupil responses are modulated by reward and loss while participants (N = 30) performed a Pavlovian reversal learning task. In fast (transient) pupil responses, we observed arousal-based influences on pupil size both during the expectation of upcoming value and the evaluation of unexpected monetary outcomes. Importantly, after incorporating eye blink rate (EBR), a behavioral correlate of striatal dopamine levels, we observed that participants with lower EBR showed stronger pupil dilation during the expectation of upcoming reward. Subsequently, when reward expectations were violated, participants with lower EBR showed stronger pupil responses after experiencing unexpected loss. Across trials, the detection of a reward contingency reversal was reflected in a slow (tonic) dilatory pupil response observed already several trials prior to the behavioral report. Interestingly, EBR correlated positively with this tonic detection response, suggesting that variability in the arousal-based detection response may reflect individual differences in striatal dopaminergic tone. Our results provide evidence that a behavioral marker of baseline striatal dopamine level (EBR) can potentially be used to describe the differential effects of value-based learning in the arousal-based pupil response.

Mechanisms, imaging and structure of tear film breakup

Tear film breakup (BU) is an important aspect of dry eye disease, as a cause of ocular aberrations, irritation and ocular surface inflammation and disorder. Additionally, measurement of breakup time (BUT) is a common clinical test for dry eye. The current definition of BUT is subjective; here, a more objective concept of "touchdown" - the moment when the lipid layer touches down on the corneal surface - is proposed as an aid to understanding processes in early and late stages of BU development. Models of BU have generally been based on the assumption that a single mechanism is involved. In this review, it is emphasized that BU does not have a single explanation but it is the end result of multiple processes. A three-way classification of BU is proposed - "immediate," "lid-associated," and "evaporative." Five different types of imaging systems are described, which have been used to help elucidate the processes involved in BU and BUT; a new method, "high resolution chromaticity images," is presented. Three directions of tear flow - evaporation, osmotic flow out of the ocular surface, and "tangential flow" along the ocular surface - determine tear film thinning between blinks, leading to BU. Ten factors involved in BU and BUT, both before and after touchdown, are discussed. Future directions of research on BU are proposed.

Transient heart rate acceleration in association with spontaneous eyeblinks

The reason why people spontaneously blink several times more frequently than is necessary for ocular lubrication has been a mystery. However, spontaneous eyeblinks selectively occur at attentional breakpoints of information processing, suggesting the involvement of spontaneous eyeblink in attentional disengagement from external stimuli. Physiological activity also changes considerably according to attention state. Heart rate decreases when attention is directed at stimuli, while it increases as attention is released. Therefore, we examined the temporal dynamics between spontaneous eyeblinks and instantaneous heart rate under natural circumstances. Our results showed that the heart rate momentarily increases after each spontaneous eyeblink while participants were freely viewing a movie or listening to a story. This phenomenon was consistently observed even when the participants were placed in a dark room. The skin conductance level on the fingers also increased after each spontaneous eyeblink, suggesting that the blink-related heart rate acceleration was induced by an increase in sympathetic nervous system activity. In contrast, no heart rate acceleration was observed to accompany spontaneous eyeblinks at rest or volitional eyeblinks. These results demonstrated that the generation of spontaneous eyeblinks and the activity of the autonomic nervous system are correlated under attentional influence of natural circumstances.

Spontaneous Eye Blink Rate (EBR) Is Uncorrelated with Dopamine D2 Receptor Availability and Unmodulated by Dopamine Agonism in Healthy Adults

Spontaneous eye blink rate (EBR) has been proposed as a noninvasive, inexpensive marker of dopamine functioning. Support for a relation between EBR and dopamine function comes from observations that EBR is altered in populations with dopamine dysfunction and EBR changes under a dopaminergic manipulation. However, the evidence across the literature is inconsistent and incomplete. A direct correlation between EBR and dopamine function has so far been observed only in nonhuman animals. Given significant interest in using EBR as a proxy for dopamine function, this study aimed to verify a direct association in healthy, human adults. Here we measured EBR in healthy human subjects whose dopamine D2 receptor (DRD2) availability was assessed with positron emission tomography (PET)-[18F]fallypride to examine the predictive power of EBR for DRD2 availability. Effects of the dopamine agonist bromocriptine on EBR also were examined to determine the responsiveness of EBR to dopaminergic stimulation and, in light of the hypothesized inverted-U profile of dopamine effects, the role of DRD2 availability in EBR responsivity to bromocriptine. Results from 20 subjects (age 33.6 ± 7.6 years, 9F) showed no relation between EBR and DRD2 availability. EBR also was not responsive to dopaminergic stimulation by bromocriptine, and individual differences in DRD2 availability did not modulate EBR responsivity to bromocriptine. Given that EBR is hypothesized to be particularly sensitive to DRD2 function, these findings suggest caution in using EBR as a proxy for dopamine function in healthy humans.

TFOS DEWS II pain and sensation report

Pain associated with mechanical, chemical, and thermal heat stimulation of the ocular surface is mediated by trigeminal ganglion neurons, while cold thermoreceptors detect wetness and reflexly maintain basal tear production and blinking rate. These neurons project into two regions of the trigeminal brain stem nuclear complex: ViVc, activated by changes in the moisture of the ocular surface and VcC1, mediating sensory-discriminative aspects of ocular pain and reflex blinking. ViVc ocular neurons project to brain regions that control lacrimation and spontaneous blinking and to the sensory thalamus. Secretion of the main lacrimal gland is regulated dominantly by autonomic parasympathetic nerves, reflexly activated by eye surface sensory nerves. These also evoke goblet cell secretion through unidentified efferent fibers. Neural pathways involved in the regulation of meibomian gland secretion or mucin release have not been identified. In dry eye disease, reduced tear secretion leads to inflammation and peripheral nerve damage. Inflammation causes sensitization of polymodal and mechano-nociceptor nerve endings and an abnormal increase in cold thermoreceptor activity, altogether evoking dryness sensations and pain. Long-term inflammation and nerve injury alter gene expression of ion channels and receptors at terminals and cell bodies of trigeminal ganglion and brainstem neurons, changing their excitability, connectivity and impulse firing. Perpetuation of molecular, structural and functional disturbances in ocular sensory pathways ultimately leads to dysestesias and neuropathic pain referred to the eye surface. Pain can be assessed with a variety of questionaires while the status of corneal nerves is evaluated with esthesiometry and with in vivo confocal microscopy.

Interactive Effects of Dopamine Baseline Levels and Cycle Phase on Executive Functions: The Role of Progesterone

Estradiol and progesterone levels vary along the menstrual cycle and have multiple neuroactive effects, including on the dopaminergic system. Dopamine relates to executive functions in an “inverted U-shaped” manner and its levels are increased by estradiol. Accordingly, dopamine dependent changes in executive functions along the menstrual cycle have been previously studied in the pre-ovulatory phase, when estradiol levels peak. Specifically it has been demonstrated that working memory is enhanced during the pre-ovulatory phase in women with low dopamine baseline levels, but impaired in women with high dopamine baseline levels. However, the role of progesterone, which peaks in the luteal cycle phase, has not been taken into account previously. Therefore, the main goals of the present study were to extend these findings (i) to the luteal cycle phase and (ii) to other executive functions. Furthermore, the usefulness of the eye blink rate (EBR) as an indicator of dopamine baseline levels in menstrual cycle research was explored. 36 naturally cycling women were tested during three cycle phases (menses–low sex hormones; pre-ovulatory–high estradiol; luteal–high progesterone and estradiol). During each session, women performed a verbal N-back task, as measure of working memory, and a single trial version of the Stroop task, as measure of response inhibition and cognitive flexibility. Hormone levels were assessed from saliva samples and spontaneous eye blink rate was recorded during menses. In the N-back task, women were faster during the luteal phase the higher their progesterone levels, irrespective of their dopamine baseline levels. In the Stroop task, we found a dopamine-cycle interaction, which was also driven by the luteal phase and progesterone levels. For women with higher EBR performance decreased during the luteal phase, whereas for women with lower EBR performance improved during the luteal phase. These findings suggest an important role of progesterone in modulating dopamine-cycle interactions. Additionally, we identified the eye blink rate as a non-invasive indicator of baseline dopamine function in menstrual cycle research.

Estimating the Osmolarities of Tears During Evaporation Through the "Eyes" of the Corneal Nerves

Purpose

A population of corneal neurons in rats preferentially sense and monitor the hyperosmolar conditions of tears when the tears begin to evaporate during corneal dryness. The present study exploited this ability in an effort to estimate tear osmolarities by comparing the responses to corneal dryness to their responses to hyperosmolar stimuli.

Methods

Extracellular recordings were performed from single neurons in the trigeminal ganglia innervating the corneas of rats. To determine the extent to which the corneal neurons' responses to drying of the cornea were induced via the activation by hyperosmolar stimuli, we assessed the responses to ocular instillation of 500 and 600 mOsm/L, and a graded series of hyperosmolar stimuli ranging from 350 to 1000 mOsm/L.

Results

The magnitudes of the responses to drying of the cornea were matched almost exactly to those induced by the ocular instillation of the 600 mOsm/L stimuli but not the 500 mOsm/L solutions. The response magnitudes to a graded series of hyperosmolar solutions were nearly linear from the 350 to the 600 mOsm/L stimuli, but reached a plateau or declined slightly thereafter.

Conclusions

Our results demonstrate that the tear osmolarity in rats could reach 600 to 1000 mOsm/L during ocular dryness. Furthermore, a spontaneous eye blink could be generated at a tear osmolarity of approximately 400 mOsm/L if the blink is solely determined by hyperosmolar tears, but ocular surface cooling also can become a major factor if hyperosmolar tears occurring during ocular dryness lower the threshold of activation of the neurons.

Neurobiological correlates of impulsivity in healthy adults: Lower prefrontal gray matter volume and spontaneous eye-blink rate but greater resting-state functional connectivity in basal ganglia-thalamo-cortical circuitry

Studies consistently implicate aberrance of the brain's reward-processing and decision-making networks in disorders featuring high levels of impulsivity, such as attention-deficit hyperactivity disorder, substance use disorder, and psychopathy. However, less is known about the neurobiological determinants of individual differences in impulsivity in the general population. In this study of 105 healthy adults, we examined relationships between impulsivity and three neurobiological metrics - gray matter volume, resting-state functional connectivity, and spontaneous eye-blink rate, a physiological indicator of central dopaminergic activity. Impulsivity was measured both by performance on a task of behavioral inhibition (go/no-go task) and by self-ratings of attentional, motor, and non-planning impulsivity using the Barratt Impulsiveness Scale (BIS-11). Overall, we found that less gray matter in medial orbitofrontal cortex and paracingulate gyrus, greater resting-state functional connectivity between nodes of the basal ganglia-thalamo-cortical network, and lower spontaneous eye-blink rate were associated with greater impulsivity. Specifically, less prefrontal gray matter was associated with higher BIS-11 motor and non-planning impulsivity scores, but was not related to task performance; greater correlated resting-state functional connectivity between the basal ganglia and thalamus, motor cortices, and prefrontal cortex was associated with worse no-go trial accuracy on the task and with higher BIS-11 motor impulsivity scores; lower spontaneous eye-blink rate was associated with worse no-go trial accuracy and with higher BIS-11 motor impulsivity scores. These data provide evidence that individual differences in impulsivity in the general population are related to variability in multiple neurobiological metrics in the brain's reward-processing and decision-making networks.

Beyond eye gaze: What else can eyetracking reveal about cognition and cognitive development?

This review provides an introduction to two eyetracking measures that can be used to study cognitive development and plasticity: pupil dilation and spontaneous blink rate. We begin by outlining the rich history of gaze analysis, which can reveal the current focus of attention as well as cognitive strategies. We then turn to the two lesser-utilized ocular measures. Pupil dilation is modulated by the brain's locus coeruleus-norepinephrine system, which controls physiological arousal and attention, and has been used as a measure of subjective task difficulty, mental effort, and neural gain. Spontaneous eyeblink rate correlates with levels of dopamine in the central nervous system, and can reveal processes underlying learning and goal-directed behavior. Taken together, gaze, pupil dilation, and blink rate are three non-invasive and complementary measures of cognition with high temporal resolution and well-understood neural foundations. Here we review the neural foundations of pupil dilation and blink rate, provide examples of their usage, describe analytic methods and methodological considerations, and discuss their potential for research on learning, cognitive development, and plasticity.

Diurnal Tracking of Blink and Relationship to Signs and Symptoms of Dry Eye

PURPOSE

To assess diurnal changes in the signs and symptoms of dry eyes and their relationship to diurnal interblink interval (IBI) in normal subjects and in subjects with dry eye.

METHODS

Blink data were collected from 9:00 AM to 8:00 PM during 2 days of normal activity using an electrocardiogram monitoring device. All subjects recorded ocular discomfort (0-5 scale) and primary activity hourly each day in a diary. Inferior and central fluorescein staining was graded by slit lamp (0-4) at the start and end of each day. Blink activity was detected using an algorithm based on recognition of the waveform corresponding to the kinematic properties of the blink signal.

RESULTS

Normal subjects (N = 12) reported negligible symptoms, and results did not show a diurnal change in group hourly IBI. Mean daily IBI for the group with dry eye (N = 15) (4.63 ± 1.63 s) was shorter than that for the normal group (5.28 ± 1.48 s) (P = 0.0483). Correlation of diurnal symptoms and mean hourly IBI was relatively weak (r = -0.248). A repeated-measures model found IBI to be significantly associated with the time of day (P = 0.0028). Inferior corneal staining showed a small but significant diurnal increase for both normal group and group with dry eyes.

CONCLUSIONS

Diurnal blink tracking reveals significant trending with symptoms. Diurnal change in IBI may be an appropriate surrogate for symptoms in the study of dry eye.

Dopamine, depressive symptoms, and decision-making: the relationship between spontaneous eye blink rate and depressive symptoms predicts Iowa Gambling Task performance

Depressive symptomatology has been associated with alterations in decision-making, although conclusions have been mixed, with depressed individuals showing impairments in some contexts but advantages in others. The dopaminergic system may link depressive symptoms with decision-making performance. We assessed the role of striatal dopamine D2 receptor density, using spontaneous eye blink rates, in moderating the relationship between depressive symptoms and decision-making performance in a large undergraduate sample that had not been screened for mental illness (N = 104). The regression results revealed that eye blink rate moderated the relationship between depressive symptoms and advantageous decisions on the Iowa Gambling Task, in which individuals with more depressive symptomatology and high blink rates (higher striatal dopamine D2 receptor density) performed better on the task. Our computational modeling results demonstrated that depressive symptoms alone were associated with enhanced loss-aversive behavior, whereas individuals with high blink rates and elevated depressive symptoms tended to persevere in selecting options that led to net gains (avoiding options with net losses). These findings suggest that variation in striatal dopamine D2 receptor availability in individuals with depressive symptoms may contribute to differences in decision-making behavior.

Human intracranial recordings link suppressed transients rather than 'filling-in' to perceptual continuity across blinks

We hardly notice our eye blinks, yet an externally generated retinal interruption of a similar duration is perceptually salient. We examined the neural correlates of this perceptual distinction using intracranially measured ECoG signals from the human visual cortex in 14 patients. In early visual areas (V1 and V2), the disappearance of the stimulus due to either invisible blinks or salient blank video frames ('gaps') led to a similar drop in activity level, followed by a positive overshoot beyond baseline, triggered by stimulus reappearance. Ascending the visual hierarchy, the reappearance-related overshoot gradually subsided for blinks but not for gaps. By contrast, the disappearance-related drop did not follow the perceptual distinction - it was actually slightly more pronounced for blinks than for gaps. These findings suggest that blinks' limited visibility compared with gaps is correlated with suppression of blink-related visual activity transients, rather than with "filling-in" of the occluded content during blinks.

Neural modulators of temperament: A multivariate approach to personality trait identification in the horse

A relationship between dopamine and temperament has previously been described in human cases of dopaminergic dysfunction. Adjustment in temperament prior to disease manifestation can enable the early identification of individuals at risk of such conditions, and scope exists to extend this application of temperament alterations to cases of dopaminergic dysfunction in horses. A multivariate and mixed-methods approach utilising a questionnaire along with two inferred measurements of dopamine activity (Spontaneous Blink Rate [SBR] and behavioral initiation rate [BIR]) were recorded from direct observation of animals (n=99) to identify the potential relationship between dopamine and temperament in horses. Principal components analysis (PCA) of 36 temperament variables revealed nine principal components, including 'Anxiety' and 'Docility', which accounted for 72.4% of the total variance. Component scores were calculated and correlated with SBR and BIR utilising Spearman rank correlation coefficient analysis. The component 'Anxiety' was found to have a significant positive relationship with SBR, whereas 'Docility' was observed to have a significant negative relationship with SBR. These results indicate a relationship between dopamine and temperament within the horse that is certainly worthy of further study. Potential mechanisms involving neural dopaminergic and GABAergic systems are presented, in addition to how such alterations could be utilised to probe for equine dopamine dysfunction pending future research.

Spontaneous eye blink rate as predictor of dopamine-related cognitive function-A review

An extensive body of research suggests the spontaneous eye blink rate (EBR) is a non-invasive indirect marker of central dopamine (DA) function, with higher EBR predicting higher DA function. In the present review we provide a comprehensive overview of this literature. We broadly divide the available research in studies that aim to disentangle the dopaminergic underpinnings of EBR, investigate its utility in diagnosis of DA-related disorders and responsivity to drug treatment, and, lastly, investigate EBR as predictor of individual differences in DA-related cognitive performance. We conclude (i) EBR can reflect both DA receptor subtype D1 and D2 activity, although baseline EBR might be most strongly related to the latter, (ii) EBR can predict hypo- and hyperdopaminergic activity as well as normalization of this activity following treatment, and (iii) EBR can reliably predict individual differences in performance on many cognitive tasks, in particular those related to reward-driven behavior and cognitive flexibility. In sum, this review establishes EBR as a useful predictor of DA in a wide variety of contexts.

Effects of meditation practice on spontaneous eyeblink rate

A rapidly growing body of research suggests that meditation can change brain and cognitive functioning. Yet little is known about the neurochemical mechanisms underlying meditation-related changes in cognition. Here, we investigated the effects of meditation on spontaneous eyeblink rates (sEBR), a noninvasive peripheral correlate of striatal dopamine activity. Previous studies have shown a relationship between sEBR and cognitive functions such as mind wandering, cognitive flexibility, and attention-functions that are also affected by meditation. We therefore expected that long-term meditation practice would alter eyeblink activity. To test this, we recorded baseline sEBR and intereyeblink intervals (IEBI) in long-term meditators (LTM) and meditation-naive participants (MNP). We found that LTM not only blinked less frequently, but also showed a different eyeblink pattern than MNP. This pattern had good to high degree of consistency over three time points. Moreover, we examined the effects of an 8-week course of mindfulness-based stress reduction on sEBR and IEBI, compared to an active control group and a waitlist control group. No effect of short-term meditation practice was found. Finally, we investigated whether different types of meditation differentially alter eyeblink activity by measuring sEBR and IEBI after a full day of two kinds of meditation practices in the LTM. No effect of meditation type was found. Taken together, these findings may suggest either that individual difference in dopaminergic neurotransmission is a self-selection factor for meditation practice, or that long-term, but not short-term meditation practice induces stable changes in baseline striatal dopaminergic functioning.

Sensitization of trigeminal brainstem pathways in a model for tear deficient dry eye

Persistent tear deficiency was sufficient to cause sensitization of neurons at multiple regions of the trigeminal brainstem and enhanced orbicularis oculi muscle activity.

Chronic dry eye disease (DE) is associated with an unstable tear film and symptoms of ocular discomfort. The characteristics of symptoms suggest a key role for central neural processing; however, little is known about central neuroplasticity and DE. We used a model for tear deficient DE and assessed effects on eye blink behavior, orbicularis oculi muscle activity (OOemg), and trigeminal brainstem neural activity in male rats. Ocular-responsive neurons were recorded at the interpolaris/caudalis transition (Vi/Vc) and Vc/upper cervical cord (Vc/C1) regions under isoflurane, whereas OOemg activity was recorded under urethane. Spontaneous tear volume was reduced by ∼50% at 14 days after exorbital gland removal. Hypertonic saline–evoked eye blink behavior in awake rats was enhanced throughout the 14 days after surgery. Saline-evoked neural activity at the Vi/Vc transition and in superficial and deep laminae at the Vc/C1 region was greatly enhanced in DE rats. Neurons from DE rats classified as wide dynamic range displayed enlarged convergent periorbital receptive fields consistent with central sensitization. Saline-evoked OOemg activity was markedly enhanced in DE rats compared with controls. Synaptic blockade at the Vi/Vc transition or the Vc/C1 region greatly reduced hypertonic saline–evoked OOemg activity in DE and sham rats. These results indicated that persistent tear deficiency caused sensitization of ocular-responsive neurons at multiple regions of the caudal trigeminal brainstem and enhanced OOemg activity. Central sensitization of ocular-related brainstem circuits is a significant factor in DE and likely contributes to the apparent weak correlation between peripheral signs of tear dysfunction and symptoms of irritation.

Neuroimaging correlates of blinking abnormalities in patients with progressive supranuclear palsy

OBJECTIVE

We aimed to identify the possible relationship between blinking abnormalities and neuroimaging changes in patients with progressive supranuclear palsy.

METHODS

We studied 18 patients with progressive supranuclear palsy and 13 healthy subjects. Voluntary and spontaneous blinking were recorded using kinematic techniques. Changes in brain structures were detected by T1-weighted magnetic resonance imaging and voxel-based morphometry. We then sought possible correlations between blinking and neuroimaging abnormalities in patients.

RESULTS

Kinematic analysis indicated several abnormalities during voluntary blinking and a markedly reduced spontaneous blink rate in patients compared with healthy subjects. Neuroimaging showed gray matter loss in cortical and subcortical structures and lower white matter volume in the brainstem. Gray matter loss in subcortical structures correlated with the prolonged pause duration between the closing and opening phases, during voluntary blinking.

CONCLUSIONS

This study provides a more specific insight into the pathophysiological mechanisms underlying blinking abnormalities in progressive supranuclear palsy.

Paroxysmal eyelid movements in patients with visual‐sensitive reflex seizures

Aim. Paroxysmal eyelid movements (PEM) are non‐epileptic episodes characterized by eyelid closure, upturning of the eyes, and rapid eyelid flutter. The aim of this study was to report clinical and EEG data of patients with PEM and its relationship with visual sensitivity.

Methods. We studied 26 patients with epilepsy (12 males and 14 females; mean age: 14.0±6.9 years) who presented PEM. The epilepsy was idiopathic generalized (eight cases), idiopathic focal (six cases), symptomatic focal (five cases), and reflex epilepsy (seven cases). PEM and blinking were analysed by video‐EEG recordings at rest and during intermittent photic stimulation, pattern stimulation, and TV watching. Blink rate was evaluated during three different conditions: at rest, during a TV‐viewing period, and at the occurrence of PEM. Analysis of variance (ANOVA) was used for statistical comparisons.

Results. Repeated episodes of PEM were recorded in all patients. The frequency of PEM ranged from 8 to 12.5 Hz (average: 9.6±1.5). PEM were accompanied by a significant increase in blinking compared to the rest condition and TV watching (blink rate: 56.5±21.1 vs 25.0±16.2 vs 11.3±11.8, respectively; p<0.0001). Photoparoxysmal EEG responses (measured as sensitivity to photic stimulation) were found in 25 cases, associated with pattern sensitivity in 22; only one patient was sensitive to pattern but not photic stimulation. Visually‐induced seizures were recorded in 20 cases, triggered by both stimuli (photic and pattern stimulation) in 11 patients; seizures were triggered by pattern stimulation (but not photic stimulation) in five, photic stimulation (but not pattern stimulation) in three, and TV watching (but not photic or pattern stimulation) in one. Epileptic eyelid myoclonia was noted in 17 patients.

Conclusion. The coexistence of PEM, photoparoxysmal EEG responses, increased blinking, and epileptic eyelid myoclonia suggests an underlying dysfunction involving cortical‐subcortical neural networks, according to the recent concept of system epilepsies. [Published with video sequences]

Mathematical model of thermal effects of blinking in human eye

Blinking is regarded as the continuous interrupted eyelid closure or opening and its thermal effect will compromise between these two. During a blink, the heat loss via convection, radiation and tear evaporation from cornea is prevented, warm tear is layered across corneal surface and the vessels of the palpebral conjunctiva provide heat to anterior eye. In most of the thermal models in human eye that are found in literatures, effect of blinking is not included, simulation is carried out only in open eye. Thus, in this paper, thermal effects of blinking are investigated using one-dimensional finite element method in transient state case. The bio-heat transfer process is simulated during different blinking rates, lid closure and opening. The simulation is carried out using normal and extreme values of ambient temperatures, blood temperatures, evaporation rates, blood perfusion rates, and lens thermal conductivities. Blinking is found to increase corneal and lens temperature by 1.29°C and 0.78°C respectively when compared to open eye. The results obtained from this model are useful in predicting temperature distribution in different laser eye surgeries, hyperthermia and cryosurgery treatment of eyelid carcinoma, choroidal melanoma and can be used for diagnosing temperature-related diseases.

Corneal sensitivity following lacrimal gland excision in the rat

PURPOSE

Dry eye disease (DED) produces ocular pain and irritation, yet a detailed characterization of ocular sensitivity in a preclinical model of DED is lacking. The aim of the present study was to assess nociceptive behaviors in an aqueous tear deficiency model of DED in the rat.

METHODS

Spontaneous blinking, corneal mechanical thresholds, and eye wipe behaviors elicited by hypertonic saline (5.0 M) were examined over a period of 8 weeks following the unilateral excision of either the exorbital lacrimal gland or of the exorbital and infraorbital lacrimal glands, and in sham surgery controls. The effect of topical proparacaine on spontaneous blinking and of systemic morphine (0.5-3.0 mg/kg, subcutaneous [SC]) on spontaneous blinking and eye wipe responses were also examined.

RESULTS

Lacrimal gland excision resulted in mechanical hypersensitivity and an increase in spontaneous blinking in the ipsilateral eye over an 8-week period that was more pronounced after infra- and exorbital gland excision. The time spent eye wiping was also enhanced in response to hypertonic saline (5.0 M) at both 1- and 8-week time-points, but only in infra- and exorbital gland excised animals. Morphine attenuated spontaneous blinking, and the response to hypertonic saline in dry eye animals and topical proparacaine application reduced spontaneous blinking down to control levels.

CONCLUSIONS

These results indicate that aqueous tear deficiency produces hypersensitivity in the rat cornea. In addition, the increase in spontaneous blinks and their reduction by morphine and topical anesthesia indicate the presence of persistent irritation elicited by the activation of corneal nociceptors.