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...
1.INVOLUNTARY-• Response to external stimuli• Afferent- CN II and VIII• Efferent- CN VII• Absent in infants2. VOLUNTARY/Co...
• early ipsilateral response- oligosynaptic pontine  pathway• late bilateral response -polysynaptic medullar  arc.• recove...
• Evaluation of blink reflex can be useful in  examining patients with systemic disease  (eg.brainstem dysfunction)• Blink...
FREQUENT BLINKINGCauses:2.Eye blinking tics- occur in boys, can be  controlled voluntarily and usually are self–  limited3...
Frequent blinking in Children• A case series study was conducted by Aghadoost  et.al., in 2002 to describe the causes of e...
▫   VA▫   Cycloplegic refraction▫   EOM▫   SLE▫   Funduscopy▫   Evaluation of excessive blinking- bright light,    lateral...
Result:• 25 (41.7%) -habitual tic• 20 (33.3%)- uncorrected refractive error• 6 (10%)- anterior segment diseases• 6(10%)- p...
• Habitual tic-  ▫ Resolved spontaneously after 3 mos• EOR-  ▫ prescribed glasses.  ▫ 20 resolved after 2 mos• Anterior se...
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 exot...
AGHADOOST et.al        COATS et. alM:F        2:1                    2:1      1.   habitual tic (41.7%)   anterior segment...
Conclusion•   Benign or self limiting•   Careful history and thorough examination•   Reassurance and proper treatment•   N...
REFERENCES• Coats DK, Paysse EA, Kim DS. Excessive blinking in  childhood: a prospective evaluation of 99 children  Ophtha...
Frequent blinking in children
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Frequent blinking in children

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Frequent blinking in children

  1. 1. FREQUENT BLINKINGin CHILDREN
  2. 2. • 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
  3. 3. 1.INVOLUNTARY-• Response to external stimuli• Afferent- CN II and VIII• Efferent- CN VII• Absent in infants2. VOLUNTARY/Controlled/ Subconscious• Spreads the tear film• Afferent- CN V• Efferent- CN VII
  4. 4. • early ipsilateral response- oligosynaptic pontine pathway• late bilateral response -polysynaptic medullar arc.• recovery curve
  5. 5. • Evaluation of blink reflex can be useful in examining patients with systemic disease (eg.brainstem dysfunction)• Blinking increases with verbal conversation• Decreases with reading
  6. 6. FREQUENT BLINKINGCauses:2.Eye blinking tics- occur in boys, can be controlled voluntarily and usually are self– limited3.Blepharospasm- adults, females4. excessive blinking due to ocular surface disorders
  7. 7. 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 15 months)
  8. 8. ▫ VA▫ Cycloplegic refraction▫ EOM▫ SLE▫ Funduscopy▫ Evaluation of excessive blinking- bright light, lateral eye movement, gentle tapping on forehead
  9. 9. 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
  10. 10. • 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.
  11. 11. Study done by Coats et al• Subjects- 99• < 16 y/o• M:F- 2:1• Follow- up- 2 mos• Excessive blinking
  12. 12. • Result:• 37%- anterior segment abnormalities• 23%- habitual tics• 14%- uncorrected EOR• 11%- Intermittent exotropia• 10%- psychogenic blepharospasm
  13. 13. AGHADOOST et.al COATS et. alM:F 2:1 2:1 1. habitual tic (41.7%) anterior segment abnormalities (37%) 2. EOR (33.3%)- habitual tics (23%) 3. anterior segment uncorrected EOR (14%) diseases (10%) 4. psychogenic blinking Intermittent exotropia (11%) (10%) 5. CNS dse ( 5%) psychogenic blepharospasm (10%)
  14. 14. Conclusion• Benign or self limiting• Careful history and thorough examination• Reassurance and proper treatment• Neurologic evaluation is unnecessary
  15. 15. REFERENCES• Coats DK, Paysse EA, Kim DS. Excessive blinking in childhood: 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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