Excessive blinking in childhood: A prospective evaluation of 99 children

Objective. To determine the characteristics and causes of excess blinking in children and to determine outcomes after treatment. Design: Prospective, noncomparative, consecutive case series. Participants: Ninety-nine consecutive children who presented for evaluation of excessive blinking over a 2 1/2 year period. Methods: Children less than 16 years of age who had excessive blinking as their sole or major chief complaint underwent detailed history and ophthalmologic examination. Treatment was recommended based on clinical examination findings. Follow-up evaluations were performed at least 2 months after initial examination. Main Outcome Measures: Etiology of excess blinking and patient characteristics in each diagnostic group. Results: The majority (89%) of children presented with bilateral excessive blinking. Boys outnumbered girls at a ratio of almost 2:1. The most common etiologies were anterior segment and/or lid abnormalities (37%), habit tics (23%), uncorrected refractive errors (14%), intermittent exotropia (11%), and psycogenic blepharospasm (10%). A history of neurologic disease was present in 22% of the patients but was not causally related to the excessive blinking in most cases. Vision-threatening disease was noted in 6% and was easily detected on standard clinical examination. Life-threatening disease was the cause in 4% of the children, but the presence of life-threatening disease was already known in all such patients. Conclusions. Excessive blinking in children can occur because of a large number of potential problems. Most cases are caused by benign and/or self-limiting conditions. The cause can usually be determined after careful history and clinical examination and routine neurologic evaluation and neuroimaging is unnecessary. (C) 2001 by the American Academy of Ophthalmology.