What Is Blepharospasm?
Blepharospasm is a type of dystonia, meaning a movement disorder that causes involuntary muscle contraction or spasm. Also known as benign essential blepharospasm, it is an involuntary and uncontrolled blinking or twitching of your eyelids. Usually blepharospasm begins gradually and becomes worse over time. While your eyes are normal, your vision is impacted by the increasingly frequent and lengthy closure of your eyelids, which in severe cases results in functional blindness.
In the past, doctors erroneously believed that the cause of blepharospasm was psychological. However, today it is considered a neuropathologic disorder. Although the cause of blepharospasm is not completely clear, it is believed to originate in the basal ganglia, the portion of the lower brain responsible for coordinated movements. There is some disruption in the circuit, which sends signals to the eyelid to blink.
In most cases, blepharospasm occurs spontaneously, with no known cause. The symptoms may gradually develop, sometimes in response to certain conditions such as fatigue, stress, excess caffeine and / or bright lights. The initial symptoms may be an increase in blinking and eye irritation. As the disorder progresses, the blinking or twitching becomes more frequent, and may also be accompanied by spasms in the face or jaw.
In some cases, blepharospasm may be a secondary disorder, meaning that it results from other eye conditions including a corneal foreign body, as well as systemic neurological diseases such as Parkinson’s Disease.
For some people, the spasms may decrease or disappear during sleep, as well as during periods of concentration on a specific task. While the spasms may start in one eye, usually both eyes will become involved. In almost half the cases of blepharospasm, patients may concurrently experience symptoms of dry eye. However, dry eye does not appear to be the cause. There may also be a family link to blepharospasm.
As the disorder progresses, other disorders including ptosis, dermatochalasis and entropion may also develop. Blepharospasm occurs in both men and women, although it is more common in middle-age and older women.
Most people will experience lid twitching at some point in their lives. Such twitching is not always a symptom of blepharospasm and does not require immediate treatment. If your symptoms last for a week or more, you should make an appointment to see your eye doctor.
How Is Blepharospasm Detected?
There is no specific test that will detect blepharospasm. Your doctor will discuss your symptoms with you and then conduct a comprehensive physical and neurological examination.
How Is Blepharospasm Treated?
The first line of treatment for blepharospasm is to disrupt the initial triggers. Wearing UV treated sunglasses when outdoors reduces the sensitivity to light. Regular cleansing of the eyelids to reduce blepharitis and inflammation may also help, as will treating the associated dry eye syndrome with artificial tears, punctal plugs and / or tear stimulating medication such as Restasis®.
Although certain oral medications may help patients with blepharospasm, the National Eye Institute (NEI) reports that the results are inconsistent and demonstrate improvement in only 15 percent of patients.
The most common, effective and least invasive treatment for blepharospasm is the injection of botulinum toxin, commonly known as Botox®, into the muscles of the eyelids. Our highly trained specialist in Oculoplastics and Neuro-ophthalmolgy administers Botox® injections at our Plymouth office.
These injections relax the eyelid muscles and disrupt the spasms. The improvement is temporary, usually lasting several months. The injections may be repeated as needed. Although side effects are rare, they can include ptosis, corneal inflammation, dry eye and double vision. If you have severe blepharospasm, particularly if you are functionally blind, the improved vision and decreased pain would usually outweigh this risk.
If the Botox® injections are insufficient to control your blepharospasm and your vision remains impaired, a surgical option called a myectomy, which removes some or all of your eyelid muscles and/or nerves, may be recommended. According to the NEI, surgical treatment of blepharospasm is effective in 75-85 percent of patients. However, since there are some risks associated with any surgical procedure, myectomy is recommended for patients with severe blepharospasm who have not responded to Botox® or other treatment.
During the surgery, which is also done by our specialist, you will feel little or no discomfort. On the day of treatment, you will be welcomed by a staff member. The staff will help you prepare for your surgery by putting eye drops in your eye. You will be given a gown to wear over your street clothes during your actual surgery.
You will be given a relaxing sedative along with local anesthetic. An injection will also be given around the eye to prevent movement. The procedure normally takes about 30-40 minutes.
Immediately after the surgery, the surgeon will place a patch over your eye, and you will rest in a comfortable reclining chair. Your family members may then join you in reviewing your follow-up care and schedule. You may be given medication or eyedrops to prevent infection.
Your eye also may be red and teary following the surgery. Your surgeon will check your eyes the morning after surgery to monitor your eye pressure, and check for signs of inflammation and infection.
Neuro-Ophthalmology Specialist at Kadrmas Eye Care New England
Meet our neuro-ophthalmologist who specializes in the treatment of neurological eye diseases and disorders: