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Understanding Blepharospasm: Symptoms, Causes, and Treatment


What is blepharospasm?


This is a rare neurological disorder of involuntary spams and contraction of the muscles in the eyelids. This can cause involuntary winking and abnormal blinking. The symptoms tend to be intermittent with good and bad days. Other symptoms include eye irritation, sensitivity to bright light (light sensitivity), It can be made worse if you suffer from dry eye which is why artificial tears are regularly recommended This is known as reflex blepharospasm. The cause is unknown and it forms one of a group of movement disorders own as focal dystonias.

What other conditions are associated with it?


It is particularly common in those that suffer from Parkinson's disease which affects movement. There may be an association with another condition that affects the muscles known as Myasthenia Gravis. Meige's syndrome is a movement disorder characterised by spasm of the eyelids and of the jaw and tongue. Meige syndrome is rare.

How is the condition diagnosed?


The diagnosis can be difficult as this condition along with simple eyelid twitches or hemifacial spasm can present in the similarly. It is diagnosed after a consultation is an oculoplastic ophthalmologist or neurologist. Electrodiagnostic tests may be used to confirm the presence of the condition.

Does blepharospasm go away?


No successful cure for blepharospasm is available at the present time. Botox or botulinum toxin injections into the eyelid muscles are a treatment for benign essential blepharospasm (primary blepharospasm) with good results. Oral medications are not as effective and have a variable effect. They tend to help in a small minority of cases. A surgical procedure to remove the nerves and muscles in the eyelids is called a myectomy is a rarely used. This treatment option and can improve symptoms in 70 percent of severe cases of muscle spasm.

How do you develop this?


Blepharospasm is caused by an abnormal function of the part of the brain that controls the movement of the muscles. It is not though to be a condition that can be caught from other people or due to an infection. Genetic factors may also play a role although no genes have yet been identified with this condition.

What medications cause blepharospasm?


Spams that are the result of medications is a subtype of the condition. It is caused by medications such as antihistamines, calcium channel blockers, serotonin reuptake inhibitors, dopaminergic agents, neuroleptic drugs and noradrenaline. Going through your medication history with your doctor to see if there are any that may be contributing to your symptoms will make sure that you are not on an medication that can be contributing to these involuntary movements. They will also assess you to make sure you have normal eyes and may carry out a neurological examination.

What does the twitching feel like?


The frequent blinking, involuntary eyelid closure, uncontrolled blinking and difficulty opening the eyes or keeping the eyes open, this can create a sensation of constant squinting, pain around the eyes, a feeling of tension or eyelid heaviness.

Is this condition a disability?


In severe cases, the muscle contractions of the eyelid can affect vision causing functional blindness. Fortunately these are rare cases. The condition can have an impact on your ability to drive or work which can be disabling. You may not realise that the DVLA classes it as a notifiable condition where you must let them know of your diagnosis if driving. Failure to do so could result in a fine.


How common is it?


Benign essential blepharospasm is more common amongst women than men. It tends to develop in the mid 50's and affects 5 in every 100,000 of the general population on average.

What causes the twitching?


The twitching is caused by abnormal signals from the brain that control the muscle movement. It is thought to stem from the area known as the basal ganglia but there is increasing evidence to suggest that other cortical parts of the brain are also involved.

Where do you inject botox to treat this?


Botulinum toxin injections are injected into the muscles of the eyelids. This causes muscle weakness and helps reduce the symptoms. Blepharospasm patients report benefit to these injections in clinical trials and they can be given every 4-6 months. Every patient varies and some patients require them less frequently and whilst others require more regular treatments. An allergic reaction to the injections is rare. On occasion the injections can cause bruising, swelling or double vision but this tends to settle with time.

Is blepharospasm the same as hemifacial spasm?


Blepharospasm is where there is an abnormal movement created by the part of the brain that controls that movement. This is known as a focal dystonia. It has been suggest that the part of the brain affect is the area known as the basal ganglia. Other dystopias include cervical dystonia which affect the neck and oromandibular dystonia or cranial dystonia which affects the mouth. It is different to hemifacial spam which is thought to be due to an abnormality or compression from an artery on the nerve of the facial muscles which causes them to twitch around the eye and the mouth, Ypu Can also know the cost of blepharospasm

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