Excessive blinking in children is not an uncommon presentation, with the parents particularly worried when it is of sudden onset. The article by Coats DK et al (Ophthalmology 2001;108:1556–61) is probably the first comprehensive report in the literature on how to evaluate and manage the child with excessive blinking. Only 5 of their 99 patients had dry eye as the cause of their blepharospasm. In three children, this was related to installation of a ceiling fan. In the other two, Stevens-Johnson syndrome and chemotherapy with radiation therapy to the orbit were implicated.
The incidence of dry eye among all age groups is higher in dry, hot weather, as the weather is in Saudi Arabia. Children are also prone to, but frequently do not verbalize, their dry eye symptoms like adults do. Over the past few months, I evaluated six children with new-onset excessive blinking. Five of them had dry eye condition. Their excessive blinking responded dramatically to lubrication with artificial tears. The sixth probably had a psychogenic blepharospasm associated with the stress of moving to a new school. It resolved on its own without intervention.
Dry eye is a minor cause of excessive blinking in children (less than 5% in this article), but is a much more likely cause (five of six) in dry, hot, or polluted weather. Ocular surface irritation, dryness, and subclinical inflammation are common in such weather.
1This may explain why five of the six children had dry eye as the cause of their excessive blinking. Keeping this in the clinician’s mind is important while managing those children in countries with dry and hot conditions.
- Eye discomfort and air pollution.Ophthalmologica. 1999; 213: 103-109
© 2003 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.