Response to Re: Blinking abnormalities in watchmaker's glaucoma pathogenesis

the directly observable pulse patterns are synchronous with the cardiac pulse and are also related to blinking and eye movement. Each systole induces an expansion of choroidal volume in the closed space of the eye, producing a transient increase in IOP that has been estimated at 3.0 mmHg and voluntary blinking induces pressure increments of five to 10 mmHg. It is thought that aqueous outflow works as a pump, propelled by these physiological IOP spikes. Histological studies of Schlemm’s canal indicate that this aqueous pump may be due to the presence of one-way valves. This continuous physiological massage could also help to propel venous blood out of the eye and could have a direct role in optic nerve head nourishment. To understand the power of blinking we should take into consideration that it is estimated that a normal person blinks thousands of times each day. We hypothesise that wearing the loupe or developing a floppy lid could induce glaucoma by preventing these continuous and beneficial IOP changes. These pressure spikes are probably too short to induce optic nerve damage but may have a role in optic nerve nourishment or aqueous humour dynamics. Against this theory, it could be stated that chronic facial paralysis has not been linked to glaucoma; however, to the best of our knowledge, this topic has not been investigated. A study on the effect of chronic facial paralysis on the optic nerve fibres could cast some light upon this topic.