Clinical characteristics and the causes of misdiagnosis or missed diagnosis in children with tic disorders (TD) first-consultation in department of ophthalrnology

Abstract

Objective To determine the clinical characteristics and the causes of misdiagnosis or missed diagnosis with tic disorders first-consultation in department of ophthalmology. Methods All 618 consecutive patients in children less than 16 years of age who had excessive blinking as their sole or major chief complaint underwent detailed history and ophthalmologic examination. Results (1) TD was diagnosed 187 of 61 g cases, the percentage was 30.3%, boys outnumbered girls at a ratio of 4.2:1, 102 patients had transient tic disorders (TTD), 62 had chronic tic disorders (CTD), and 23 had Tourette's syndrome (TS). (2) 123 patients (65.8%) had only eye tics as their chief complaint, and the other had others complaints with eye; 78 patients (41.7%) had no any organic eye pathology, 67 had conjunctival injection, follicle and papilla, 42 had others eye abnormalities; all patients had motor tics, only 37 had vocal tics; 171 patients had simple tics, mainly facial tic;and 47 patients had a variety of neurobehavioral symptoms, mainly associated with ADHD. (3) 58 of 8l cases who had consulted in other department of ophthalmology were been misdiagnosis or missed diagnosis. Conclusions TD is the common cause in children with excessive blinking. The clinical characteristics is manifested in a spectrum of main type of TTD, simple motor tics, main facial tic, a few of neurobehavioral disturbances and coexisting organic eye pathology. Ophthalmologists have few knowledge and neglect of it and coexistence of organic eye pathology are the main causes of misdiagnosis. Key words: Tic disorders; Excessive blinking; Clinical characteristics; Misdiagnosis