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Question:
I am a school psychologist and I recently evaluated a 7-year-old boy whose right eye blinked but his left eye did not. What could be possible causes for one-eyed blinking? There is a possibility that he has fetal alcohol syndrome, although this has not been confirmed.  

Answer:
This child likely has a simple motor tic. Children, just like adults, can develop a tic. Children often manifest their tics with bilateral forceful eyelid blinking or one-side blinking. It is often worse during times of fatigue or stress. It can wax and wane. It may disappear over time. If the tic has not disappeared in one year, the patient would receive the diagnosis of chronic tic disorder.

It is important to refer the patient to an ophthalmologist to rule out allergic conjunctivitis, corneal diseases, intraocular inflammation, and to perform a complete eye examination. If the exam is within normal limits the patient likely has a motor tic. Tic is made worse with certain medications such as ADHD medications. Eyelid blinking can be the first manifestation of Tourette's syndrome. If there are other tic symptoms such as shoulder shrugging, coughing or vocalizations, Tourette's syndrome would likely be the diagnosis. 

Referral to a pediatric neurologist comfortable with motor disorders may be indicated. Fetal alcohol syndrome has not been associated with tic to my knowledge. 

Answered by: Jane C. Edmond, MDDr. Jane C. Edmond

Categories: Eye Conditions, Children's Eye Health

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Answered: Jan 03, 2013

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