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What is Blepharospasm?

Very mild and common twitching of the eyelids is usually referred to as a tic, twitch or flicker of the eyelid. Blepharospasm (or benign essential blepharospasm) is the term used to describe involuntary spasm of the eyelids resulting in uncontrolled blinking, narrowing, and even closing of the eyelids due to muscle spasm. It can affect one or both eyes, and in severe cases, the person may have difficulties keeping their eyes open. Although it is a not life-threatening spasm disorder (or dystonia), with time the spasms often become increasingly more pronounced and frequent.

In severe cases, the person is rendered legally blind because the muscular spasms force the eyelids shut, sometimes for hours. A person with blepharospasm may give up activities such as sports, driving or socialising for fear of ‘losing’ their eyesight to a muscular spasm.

What causes it?

Some of the disorders and conditions associated with blepharospasm include dry eyes, cerebral palsy and Tourette’s syndrome. However, most cases occur spontaneously (idiopathic). It can affect men and women of any age, but middle-aged and older women appear to be more susceptible.

The cause of blepharospasm is unknown, but abnormalities in the way the brain is working are thought to be involved. No one knows what causes the dysfunction or damage.

How do doctors diagnose it?

There is no particular test for blepharospasm. Diagnosis relies on physical examination by a specialist, medical history and ruling out other possible ocular causes, such as blepharitis, conjunctivitis and dry eye.

Blepharospasm is often misdiagnosed or not diagnosed at all, because it shares similar characteristics with a range of other problems including ptosis (droopiness) of the eyelids. Particular drugs such as antipsychotic medications and drugs to treat Parkinson’s disease can cause similar symptoms to blepharospasm, and some drugs are known to trigger blepharospasm in susceptible people.

Treatment for blepharospasm

There is no cure for blepharospasm, but several treatment options can reduce the severity.

  • Stress management – symptoms tend to worsen in times of emotional stress. Learning stress management techniques and joining a support group can be helpful. Identifying ‘triggers’ and reducing these can be helpful, such as wearing sunglasses in bright light and using artificial tears for dry eyes.
  • Muscle relaxant (toxin) injections – when injected, the toxin disrupts nerve messages to muscles and causes paralysis. Generally, multiple injections are given both above and below the eye. It takes between one and four days for the paralysis to begin. The complete effect usually takes about a week. The treatment often lasts up to four months. Muscle relaxant injections work for about 90% of people with blepharospasm, and is currently the most commonly used treatment. Common but temporary side effects include dry eyes, drooping eyelids (ptosis). Rarely, double vision can occur, but fortunately, this is temporary. Short-term blurry vision can occur due to drying of the eye surface, but this is easily treated with artificial tears.
  • Medication – medications such as lithium and diazepam are sometimes used, but the success rate varies. There is no standard treatment regime because a particular medication may bring relief to one person, but not another. Medication is helpful in only around 15% of cases.
  • Surgery – myectomy is an operation involving the removal of some of the eyelid and eyebrow muscles and nerves responsible for the spasm. This procedure is reserved for those that have failed injection therapy. Repeat operations may be needed in some cases. Myectomy improves the symptoms of blepharospasm in up to 80% of people.
  • Muscle-Relaxant injections are available at Eye Specialist Institute for the treatment of blepharospasm, hemifacial spasm, and strabismus.