frequent blinking

8/6/2019 Frequent Blinking

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FREQUENT BLINKINGin CHILDREN



� Normal rate- 1 in every 5 sec of 0.3 sec duration

� neonates:1-4 /min� Adolescent to adults:12-15/min

� Protection from unwanted stimuli

Irritation of the cornea, conjunctiva, eyelashes

Bright light/glare Loud noise

� Allows the spread of tear film



1.INVOLUNTARY-

� Response to external stimuli� Afferent- CN II and VIII

� Efferent- CN VII

� Absent in infants

2. VOLUNTARY/Controlled/ Subconscious� Spreads the tear film

� Afferent- CN V

� Efferent- CN VII



� early ipsilateral response- oligosynaptic pontine

pathway � late bilateral response -polysynaptic medullararc.

� recovery curve



� Evaluation of blink reflex can be useful in

examining patients with systemic disease(eg.brainstem dysfunction)

� Blinking increases with verbal conversation

� Decreases with reading



FREQUENT BLINKING

Causes:

1. Eye blinking tics- occur in boys, can becontrolled voluntarily and usually are self±limited

2. Blepharospasm- adults, females

3. excessive blinking due to ocular surfacedisorders



Frequent blinking in Children

� A case series study was conducted by Aghadoost

et.al., in 2002 to describe the causes of excessive blinking in childhood

� 60 subjects-30 males (65%), 21 females (35%)

� age: 3.5 to 16 y/o ( mean- 10)

� Bilateral excessive blinking ( 7 days to 15months)



VA

Cycloplegic refraction EOM

SLE

Funduscopy

Evaluation of excessive blinking- bright light,lateral eye movement, gentle tapping on forehead



Result:

� 25 (41.7%) -habitual tic� 20 (33.3%)- uncorrected refractive error

� 6 (10%)- anterior segment diseases

� 6(10%)- psychogenic blinking

� 3 (5%)- central nervous system diseases



� Habitual tic- Resolved spontaneously after 3 mos

� EOR- prescribed glasses. 20 resolved after 2 mos

� Anterior segment disease-

4/6 cases resolved after proper treatment� Psychogenic blepharospasm-

dx w/ history of stressful condition ( eg new environment, examination)

4/6 resolved after 3 mos.



Study done by Coats et al

� Subjects- 99� < 16 y/o

� M:F- 2:1

� Follow- up- 2 mos

� Excessive blinking



� Result:

� 37%- anterior segment abnormalities� 23%- habitual tics

� 14%- uncorrected EOR

� 11%- Intermittent exotropia

� 10%- psychogenic blepharospasm



AGHADOOST et.al COATS et. al

M:F 2:1 2:1

1. habitual tic (41.7%) anterior segment

abnormalities (37%)

2. EOR (33.3%)- habitual tics (23%)

3. anterior segmentdiseases (10%)

uncorrected EOR (14%)

4. psychogenic blinking(10%)

Intermittent exotropia (11%)

5. CNS dse ( 5%) psychogenic blepharospasm(10%)



Conclusion

� Benign or self limiting

� Careful history and thorough examination� Reassurance and proper treatment

� Neurologic evaluation is unnecessary



REFERENCES

� Coats DK, Paysse EA, Kim DS. Excessive blinking inchildhood: a prospective evaluation of 99 children

Ophthalmology. 2001 Sep;108(9):1556-1561.� Aghadoost et.al., EVALUATION OF EXCESSIVE

BLINKING IN CHILDHOOD Acta Medica Iranic.2004

� Frank Newell. Ophthalmology Principles and Concepts . Missouri:Mosby- Year Book 1996 p. 203� Suthphin et.al., American Academy of

Ophthalmology Section 8 External Disease and Cornea 2008-2009 p. 205

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