Clinical Application of Lid Movements

Blinks and the Initiation of Eye Movements

Under certain circumstances, blinks might slow eye movements down, speed them up, or elicit specific eye movements. Patients with posterior fossa lesions, for example, were found to have saccades of normal velocity, but only if a blink was simultaneously elicited [156]. In patients with ocular flutter and opsoclonus, eye movement oscillations are often elicited by blinks [157, 158].

Peli and McCormack [159] reported on a patient with uncorrected antimetropia (one eye is myopic, the fellow eye hyperopic) who achieved motor fusion by blinking. Although this patient could have used saccadic vergence and slow fusional vergence, he usually relied on blink vergence. These observations might also be explained by the inhibition of OPNs.

Blinks may also be used to initiate saccades in ocular motor apraxia [160]. Ocular motor apraxia is characterized by the loss of voluntary control of saccades but by preserved reflectory saccades of the optokinetic reflex and the vestibulo-ocular reflex. Most of these clinical observations have been attributed to the inhibition of OPNs, which facilitates the execution of saccades.

Blinks Unmasking Vestibular Imbalance

Blinks may exhibit blink-related torsional quick-phase-like eye movements in patients with acute or persisting vestibular tone imbalance, e.g. in vestibular neuritis or a circumscribed brainstem infarction in the vestibular nuclei [161]. These blinks were followed by slow drifts with a time constant of 1–2 s, suggesting an unmasking of a vestibular tone imbalance. It has therefore been proposed that blinks might be another useful clinical test for identifying a persistent vestibular failure once spontaneous nystagmus has resolved.

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Prof. Dr. Christoph Helmchen

Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck Ratzeburger Allee 160

DE–23538 Lübeck (Germany)

Tel. 49 451 500 2927, Fax 49 451 500 2489 E-Mail christoph.helmchen@neuro.uni-luebeck.de