A novel lid seal evaluation: the Korb-Blackie light test

To develop a clinical method to qualitatively evaluate whether a compromised moisture seal is possible even when the lids are apparently closed and to compare these findings with symptoms of ocular discomfort on awakening.

Patients (n=116) were fully consented and enrolled. The Korb-Blackie lid-light evaluation was performed by placing a transilluminator against the relaxed, closed, outer upper eyelids of semi-reclined patients. The amount of visible light emanating from the lid area between the lashes was quantified on a scale of 0 to 3, where 0=no light, 1=minimal, 2=moderate, and 3=severe for temporal, central, and nasal sections of the eyelids. Eye discomfort on awakening was quantified on a scale of 0 to 2 (0=no discomfort, 1=mild, and 2=significant discomfort).

Data are presented for right eyes only. The mean age of the patients was 52.6±16.8 years. The central lid section had a positive lid-light score (54.3%), significantly more frequently than the nasal (37.9%) or temporal (21.6%) lid sections (P<0.0001). Patients with a positive lid-light evaluation were significantly more likely to have symptoms of discomfort on awakening (P<0.0001).

Light emanating from between "closed" lids during the Korb-Blackie lid-light evaluation is associated with symptoms of ocular discomfort on awakening. These symptoms of discomfort may be linked to the inability of the lids to achieve an adequate seal to prevent subtle ocular surface desiccation during sleeping.