Excessive blinking in childhood: A prospective evaluation of 99 children

Objective. To determine the characteristics and causes of excess blinking i n 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 t heir sole or major chief complaint underwent detailed history and ophthalmo logic examination. Treatment was recommended based on clinical examination findings. Follow-up evaluations were performed at least 2 months after init ial examination. Main Outcome Measures: Etiology of excess blinking and patient characterist ics 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 pre sent in 22% of the patients but was not causally related to the excessive b linking in most cases. Vision-threatening disease was noted in 6% and was e asily detected on standard clinical examination. Life-threatening disease w as the cause in 4% of the children, but the presence of life-threatening di sease was already known in all such patients. Conclusions. Excessive blinking in children can occur because of a large nu mber of potential problems. Most cases are caused by benign and/or self-lim iting conditions. The cause can usually be determined after careful history and clinical examination and routine neurologic evaluation and neuroimagin g is unnecessary. (C) 2001 by the American Academy of Ophthalmology.