Essential blepharospasm is a debilitating disorder of progressive, involuntary spasms of the eyelid muscles. Other muscles in the face or neck may be involved as well. Terms that sometimes are used in the description of this problem include dystonia (impaired or disordered muscle tone) and dyskinesia (a defect involuntary movement). The onset of blepharospasm is typical during the patient’s 50s or 60s and is more common in women than in men. Although the cause of essential blepharospasm is not completely understood, it is thought to be a result of “miscommunication” in the area(s) of the brain responsible for the control of the involved muscles.
The onset of essential blepharospasm usually is heralded by an increase in blinking or squinting with progression toward repetitive forceful closure and difficulty opening the eyelids. Blepharospasm is often made worse by stress, fatigue, bright lights, watching television or driving, and social interactions. Functional blindness in the presence of an otherwise normal visual system may result. Sleep, relaxation, walking, talking and other “tricks” may alleviate symptoms temporarily.
Medications such as muscle relaxants, depressive and mood elevator do not typically work with most blepharospasm conditions.
Systemic medications have limited effectiveness in treating the disease. However, some patients do benefit from such therapy alone or in conjunction with other treatments. Local injection of a medication called botulinum toxin (Botox®) lasts approximately three to six months, after which time the injections need to be repeated for continued relief. As with any medication, Botox® has side effects, fortunately, these typically are mild and temporary. For those patients who do not respond to Botox® and/or systemic medications, there are surgical options.
Essential blepharospasm is a diagnosis of exclusion and the course of the disorder can fluctuate. Spontaneous remissions and exacerbations are possible, but for most patients the disease is chronic. A thorough ophthalmic examination is necessary to diagnose essential blepharospasm because eyelid spasms frequently are secondary to ocular conditions such as blepharitis (lid inflammation), abnormal eyelashes, infections, corneal diseases, intraocular inflammation, acute glaucoma, and occasionally, cataract or macular diseases. Dry eyes may be the cause of eyelid spasms or can aggravate coexisting essential blepharospasm. Treatment of dry eye or other ocular conditions may reduce eyelid spasm to a level that the patient can tolerate without the need for additional medications or injections.
A related disorder, hemifacial spasm, involves involuntary spasms of muscles on only one side of the face. This problem usually is caused by abnormal stimulation of the facial nerve, which travels from the brain to the facial muscles. Hemifacial spasm responds well to Botox® injections in most patients. If the spasms are severe, a neurosurgical operation can be done to prevent the facial nerve from being abnormally stimulated. Many times, hemifacial spasm can occur as a result of 7th nerve palsy or bell’s palsy.
