This document discusses frequent blinking in children. It notes that normal blinking rates vary from 1 blink every 5 seconds for adults and adolescents to 1-4 blinks per minute for neonates. Frequent blinking in children can be caused by habitual tics, uncorrected refractive errors, anterior segment diseases, psychogenic factors, or central nervous system diseases. Two studies found that the most common causes were anterior segment abnormalities, habitual tics, and uncorrected refractive errors. The document concludes that most cases of frequent blinking in children are benign and self-limiting, and can be addressed through careful examination, treatment if needed, and reassurance.

1. FREQUENT BLINKING
in CHILDREN

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. 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

4. • early ipsilateral response- oligosynaptic pontine
pathway
• late bilateral response -polysynaptic medullar
arc.
• recovery curve

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. FREQUENT BLINKING
Causes:
2.Eye blinking tics- occur in boys, can be
controlled voluntarily and usually are self–
limited
3.Blepharospasm- adults, females
4. excessive blinking due to ocular surface
disorders

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. ▫ VA
▫ Cycloplegic refraction
▫ EOM
▫ SLE
▫ Funduscopy
▫ Evaluation of excessive blinking- bright light,
lateral eye movement, gentle tapping on forehead

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. • 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. Study done by Coats et al
• Subjects- 99
• < 16 y/o
• M:F- 2:1
• Follow- up- 2 mos
• Excessive blinking

12. • Result:
• 37%- anterior segment abnormalities
• 23%- habitual tics
• 14%- uncorrected EOR
• 11%- Intermittent exotropia
• 10%- psychogenic blepharospasm

13. 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 segment uncorrected EOR (14%)
diseases (10%)
4. psychogenic blinking Intermittent exotropia (11%)
(10%)
5. CNS dse ( 5%) psychogenic blepharospasm
(10%)

14. Conclusion
• Benign or self limiting
• Careful history and thorough examination
• Reassurance and proper treatment
• Neurologic evaluation is unnecessary

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