![]() ![]() The more light that “escapes” the interpalpebral fissure, the higher degree of dysfunction and greater exposure to desiccating stress at night (see Figure 1). If light escapes between the eyelids, the patient’s lid seal is inadequate. ![]() In a dark room, gently place a muscle light or transilluminator at the upper tarsus of a closed eye and direct the light toward the interpalpebral fissure. The test can be carried out in any exam room with basic equipment. ![]() The “Korb-Blackie Lid Leak Test” is a simple and effective way to identify dry eye and MGD patients with insufficient lid seal (3). Proactively addressing this problem is important, as desiccating stress is a known trigger for chronic inflammation leading to chronic dry eye disease (2). When the eyelids’ protective biomechanics are insufficient, they leave the ocular surface exposed at night, and desiccating stress is inevitable without a more specific and robust treatment strategy. For these patients, avoiding fans, allergens and other commonplace aggravators simply isn’t adequate. Given this understanding, it is crucially important that we adjust our diagnostic algorithms to identify dry eye and MGD patients with poor lid functionality – those patients who are particularly susceptible to nocturnal lagophthalmos. Interestingly, patients with asymptomatic dry eye show comparatively and significantly less lid seal failure, and the severity of a patient’s lid performance failure correlates heavily to the degree of dry eye symptom severity observed. Recent research establishes that compromised lid seal – a condition wherein a patient’s eye lids remain partially open during sleep – potentially affects up to 79 percent of all symptomatic dry eye patients across diverse demographic groups (1). It is only by recognizing and minimizing the impact of nocturnal lagophthalmos that a protective ocular surface environment can be recreated. ![]()
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