Chapter 96 My child keeps blinking and closing his eye
History
1. Enquire about associated symptoms and signs. Redness, tearing, discharge, mucus, and clouding of the cornea indicate an ocular surface disorder. There may be a history of atopy, or recent eye lid vesicles suggesting primary herpes simplex virus infection. Potentially significant ocular trauma or foreign body exposure is often unreported by children unless specifically asked about.
2. Ask about the circumstances in which the blinking or unilateral eye closure is most evident. There are characteristic factors that exacerbate or ameliorate tics (see below). Previous episodes of self-limiting unilateral or bilateral increased blinking at the appropriate age also suggest tic disorder.
3. Ask if there is a family history of refractive error, amblyopia, or squint (see below).
Examination
1. Whilst questioning the parents, observe the child surreptitiously for the characteristics of an eye winking or blinking tic or other simple motor or phonic tics.
2. The ophthalmological examination should include elimination of uncorrected refractive error as a potential cause and an orthoptic assessment for heterophoria.
3. Slit-lamp examination should include exclusion of lid margin malposition, lash abnormalities, and a foreign body (including subtarsal). Superior limbal vernal keratoconjunctivitis may be missed unless specifically looked for; look also for signs suggesting corneal anesthesia such as opacity and superficial vascularization.
