Blepharospasm and Hemifacial Spasm

What is Blepharospasm?

Blepharospasm is an abnormal blinking of the eyelids which is involuntary in nature. It is a focal cranial dystonia. Any movement disorder that results in muscle contraction and involuntary spasms is known as dystonia or Hemifacial Spasm.

Who Does Blepharospasm Affect?

Blepharospasm affects more females than males, to a ratio of 1.8:1. The average age of onset is 56 years, but more than 65% of the patients suffering from blepharospasm are 60 years or older. 

How Does Blepharospasm Occur?

Blepharospasm is a neuropathological disorder. Evidence suggests that blepharospasm is associated with an abnormally functioning basal ganglion, due to an unknown cause. 

The basal ganglion is the component of the brain responsible for muscle control. 

Causes Of Blepharospasm?

There is no specific causation or etiology that has been identified for blepharospasm. This condition is considered to be hereditary in very rare cases. Investigations into determining whether genetic and environmental conditions have a larger role in its manifestation are currently being conducted. 

There have also been reports of individual cases of blepharospasm associated with extensive consumption of caffeine and also existing eye conditions.

Symptoms of Blepharospasm

The symptoms of blepharospasm are limited to the bilateral eyelids. The symptoms often begin as mild and infrequent twitches and increased blinking at first, which become more frequent and forceful over time, only stopping when the individual falls asleep. 

There can be functional blindness in advanced cases as there are periods when eyes cannot be kept open at all. Photophobia is also reported by patients as well as the sensation of having ‘dry eyes’. 

Types Of Blepharospasm

Blepharospasm is either primary (also known as essential) or secondary. Benign essential blepharospasm (BEB) affects both eyelids (bilateral condition) and occurs on its own. Blepharospasm can also be secondary as part of another disorder such as Meige syndrome or extrapyramidal disorders.

Stages Of Blepharospasm

There are no stages, but the severity of the sensitivity is gradient and depends on how progressed the disorder is.

How is Blepharospasm Diagnosed?

History of the current illness plays a great role in helping the physician make a diagnosis. It is diagnosed on the basis of history and physical examination. 

How is Blepharospasm Treated?

There is no specific cure to treat blepharospasm. Botox (botulinum) injections are the treatment of choice to provide relief, which needs monthly administration, due to their short time effect. 

It paralyzes the muscles of the eyelids.  Artificial tears are also prescribed to treat dry eyes syndrome. Muscle relaxants can be given as a secondary option. However, if the Botox injections have been ineffective, surgery is the alternative option. 

Myectomy is performed which removes some of the nerves of the eyelids and muscles, improving symptoms. 

What If Blepharospasm Is Untreated

If left untreated, it can result in significant degradation in the quality of life for the patients. Advanced symptoms and twitching can cause functional blindness and make routine tasks of daily living such as reading, driving and using a computer almost impossible. 

The psychological anxiety and stress caused by this uncontrollable phenomenon are also a great concern and need support to be addressed.