Blepharospasm

Overview

Blepharospasm is the more commonly used term for Essential Blepharospasm, which is a relatively uncommon eye condition characterized by an involuntary contraction of the eyelid muscles. It is more common in females than in males by a ratio of 3:1. In severe cases, it can be extremely debilitating, as it can produce temporary blindness from the eyes being uncontrollably closed. Blepharospasm is typically a bilateral condition and generally occurs more often in people past age 60.

The orbicularis oculi is the ocular muscle mainly involved in blepharospasm, but upper facial muscles can also be affected. Spasms are often precipitated by activities that are stressful to the eyes, such as reading, driving, stress, and bright lights. Relief from blepharospasm can be accomplished by talking, walking, sleeping, and general relaxation.

Blepharism can be accompanied by muscle contractions in the lower facial muscles as well as the neck muscles. Two known syndromes exist that have been categorized according to the muscles involved:

Meige syndrome
A combination of blepharospasm along with muscle contractions in the lower facial muscles as well as the neck muscles.

Breughel syndrome
Blepharospasm accompanied by severe mandibular (jaw) involvement.

Blepharospasm Treatment

Historically, blepharospasm was thought to be a sign of a psychological disorder and patients with symptoms of blepharospasm were institutionalized. This is now known to be false, however, and treatments for blepharospasm are directly related to nerve activity at the site of the muscles involved.

Botox injections are quickly becoming the treatment of choice for temporary relief of blepharospasm symptoms. Botulinum toxin forces the muscles to relax; its effects generally last about 3-4 months. While botox injection is the best form of treatment so far for blepharospasm, it does have its side effects, which include the following: lagophthalmos (drooping eyelids), and ectropion or entropion. If the botulinum toxin is injected too deep such that it affects the muscles that move the eye (the extraocular muscles), double vision and blurred vision may also occur.

For those individuals who either do not respond to botulinum toxin injections or who prefer not to have them, alternatives do exist, but with poor results. There are a number of anticholinergic drugs that can be administered orally (pills) in an attempt to relax the muscles. Alternatively, a surgical procedure known as a protractor myectomy is an option. In this procedure, the orbicularis oculi (the muscle involved in blepharospasm) is either partially or completely removed.

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