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