Encyclopedia - Blepharospasm

What are the signs of blepharospasm?
How is blapharospasm treated?

What are the signs of blapharospasm?

A blepharospasm is a chronic, continuous, involuntary blinking or forcible closure of the eyelids. It is caused by a dysfunction of the area of the brain that controls the muscles around the eye. Other facial muscles can twitch as well, particularly those around the cheek and brow. Severe cases can cause the eyelids to forcibly close for a longer period than the typical blink, disrupting vision.

Symptoms occur most frequently in persons who are between the ages of 50 and 70. Women are three times more likely to develop the condition than men are.

Blepharospasm should not be confused with ptosis, which is drooping of the eyelids caused by weakness or paralysis of a muscle in the upper eyelid. Another condition, called hemifacial spasm, affects muscles on one side of the face, often including the eyelid. The muscle contractions from this disorder are more rapid and transient, and they always affect just one side of the face. Blepharospasm usually affects both eyes.

How is blapharospasm treated?

Mild cases of blepharospasm are sometimes treated with medications. However, drug therapy is difficult, because there is no fixed or best regime. One drug may work for some patients and not for others. Biofeedback training can also be helpful in mild cases. Walking, extra sleep, talking, and relaxation techniques may lessen symptoms. Unfortunately, most cases require treatment beyond these measures.

The preferred treatment for many patients is the injection of botulinum toxin (Botox). Although the same bacterium responsible for botulism food poisoning produces this toxin, it is safe in minute doses and effective in stopping eyelid spasms. Botulinum toxin is injected with a very fine needle into the eyelid, the brow, or the muscles under the lower lid. It starts working in 1 to 14 days and lasts an average of 3 to 4 months. Then the patient needs another injection.

Long-term studies have shown that Botox injections are safe and effective for 90 percent of patients. Side effects can be drooping eyelids, blurred vision, double vision, and excessive tearing. These are usually minor and correct themselves.

Patients who have not responded well to medication or botulinum toxin may be candidates for surgical therapy. Removing some or all of the muscles responsible for eyelid closure is the most effective surgical treatment for blepharospasm.