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8/6/2019 Frequent Blinking
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FREQUENT BLINKINGin CHILDREN
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� 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
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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
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� early ipsilateral response- oligosynaptic pontine
pathway � late bilateral response -polysynaptic medullararc.
� recovery curve
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� Evaluation of blink reflex can be useful in
examining patients with systemic disease(eg.brainstem dysfunction)
� Blinking increases with verbal conversation
� Decreases with reading
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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
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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)
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VA
Cycloplegic refraction EOM
SLE
Funduscopy
Evaluation of excessive blinking- bright light,lateral eye movement, gentle tapping on forehead
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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
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� 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.
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Study done by Coats et al
� Subjects- 99� < 16 y/o
� M:F- 2:1
� Follow- up- 2 mos
� Excessive blinking
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� Result:
� 37%- anterior segment abnormalities� 23%- habitual tics
� 14%- uncorrected EOR
� 11%- Intermittent exotropia
� 10%- psychogenic blepharospasm
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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%)
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Conclusion
� Benign or self limiting
� Careful history and thorough examination� Reassurance and proper treatment
� Neurologic evaluation is unnecessary
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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