Blepharospasm

What is blepharospasm?

Blepharospasm is involuntary spasm or repeated twitching of eyelids. It may affect one or both eyelids of an eye, or it may affect both eyes. It may be mild or even subtle but, in some patients, it may be severe enough to shut the eye(s) closed with every spasm.

 

Are there different types of blepharospasm?

It is usually divided in two types: primary and secondary types. Primary means that a cause, by usual testing methods, has not been found. It does not mean that there is no cause. Secondary type of blepharospasm is caused by a different known condition.

 

What may be the cause of primary blepharospasm?

Its cause is most likely is in the brain, a malfunction of a brain circuitry. Usual brain scans like a CAT scan or MRI scan do not show any abnormality but a functional brain scan like a functional MRI may show many. This type of testing though is not generally available and is done in research setting.

 

What are common causes of secondary blepharospasm?

Most of the causes are related to the eye or eyes. Anything or any condition that may irritate the eye can lead to excessive blinking or spasm. Cause of irritation may be within eyes or outside. This is the reason that a patient with blepharospasm should consult an ophthalmologist. Examples of outside causes may be bright light or an environmental irritant. Some neurological conditions like dyskinesia or Parkinsonism may also cause blepharospasm, which are diagnosed by a neurologist.

 

What are the risk factors for blepharospasm?

Women are more prone to this condition. Other risk factors are stress, anxiety disorder and some other psychological disorders leading to anxiety, exposure to certain drugs like antipsychotics, certain eye conditions causing eye dryness or irritation, and family history of blepharospasm.

 

What conditions may look like blepharospasm?

There are conditions that may look like blepharospasm but are a little different. Common examples are hemifacial spasm, facial tic disorder, tardive dyskinesia, myokymia, apraxia of eyelid opening, or a foreign body in the eye. In a different condition called Meige syndrome, patients have blepharospasm and some other facial movement disorder. 

 

How is blepharospasm treated?

The first step is to rule out a fixable cause. An ophthalmology consultation can help to rule out causes related to the eye. In some patients, a rheumatology or a psychiatry consultation may  be helpful. If no fixable cause is found, its treatment can be considered, usually by a neurologist.

Treatment starts with patient education and reassurance, as this condition can be anxiety or stress provoking. Some may need formal counseling or behavioral therapy. If they are properly educated and assured, patients with mild condition may not need any more treatment. Other than treating anxiety associated with it, there is no known medicine or a pill for its resolution. Treatment of choice is Botox injection. If for some reason Botox fails, and the condition is significant, there is a surgical option. Botox is reasonably effective and require reinjection every 3-6 months. Some patients may recover after a few treatments and may require a less frequent injection schedule. It is important to note that Botox does not fix its cause, which is in the brain. It only makes muscles around the eye little weak so that they do not spasm or blink as much or as forcefully.

 

Where can I get more information about blepharospasm?

1. American Academy of Neurology
2. International Parkinson and Movement Disorder Society