Welcome to question of the day #41

Welcome to question of the day #41

Why do some patients display exaggerated, forceful blinking?

This is usually seen in paediatric patients but sometimes noted in patients with psychological problems and others with EEG (electroencephalogram) anomalies

Most often noted at a time of developmental stress. It is very rarely due to lid disease. It is worthwhile having a family member check whether this exaggerated blinking ceases during sleep. Helping to further insure against organic neuro disorder by testing cranial nerves and asking about other signs and symptoms.

Management

Treat any active lid disease, treat refractive error, treat binocular disorders.

Neurologic consultation is indicated if other neuro signs are discovered.

Psychological consultation is indicated if behavioral problems, developmental lags, adjustment problems, etc., are noted.

Management

Reassurance.

Encourage parents to try and ignore the problem!

Encourage parents not to make an issue of the problem!

Advise the regular use of artificial tears, and tell the patient that the drops will ‘soothe the eye, making hard blinking unnecessary’.