What is the workup and treatment for blepharospasm (eye tic disorder) in a 6-year-old child?

For a 6-year-old child with an eye tic disorder, the initial approach should be watchful waiting and parent education, as most childhood tics are transient and resolve without treatment within 3-12 months. Begin with a thorough medical history and physical examination to rule out other conditions like allergies, vision problems, or neurological disorders. Reassure parents that tics often worsen with stress, fatigue, or attention to them. Environmental modifications are the first-line treatment: reduce stress, ensure adequate sleep, and avoid calling attention to the tics. Behavioral interventions like Comprehensive Behavioral Intervention for Tics (CBIT) or habit reversal training can be effective, teaching the child to recognize premonitory urges and perform competing responses. Medication is rarely needed for simple tics but may be considered if tics significantly impair functioning. If medication is necessary, options include clonidine (starting at 0.05 mg daily, gradually increasing) or guanfacine (0.5-1 mg daily). These alpha-2 adrenergic agonists have fewer side effects than antipsychotics like risperidone or aripiprazole, which are reserved for severe cases. Regular follow-up is important to monitor tic progression and treatment response, typically every 3-6 months or sooner if symptoms worsen.