Blepharospasm

The cause of blepharospasm is most often unknown (1). It affects women more than men and tends to occur in families (2). It is a chronic neurological movement disorder that is classified as a focal dystonia. Rarely, blepharospasm may be secondary to eye disorders, including those that cause ocular irritation (eg, trichiasis, an inward growing eye lash), corneal foreign body, keratoconjunctivitis sicca (dry eye), and systemic neurologic diseases that cause dystonias (eg, Parkinson disease).

Symptoms are involuntary blinking that can progress to sustained spasms and difficulty opening the eyes; in severe cases, patients cannot open their eyes. Spasms may be made worse by fatigue, bright light, and anxiety.

The diagnosis is clinical, based on characteristic bilateral, involuntary, repetitive spasms of the orbicularis oculi muscles, often accompanied by increased blinking and difficulty keeping the eyes open.

Treatment of blepharospasm involves injecting botulinum toxin type A into the eyelid muscles (orbicularis oculi); treatment must be repeated in most instances (3). Anxiolytics may help. Surgery to resect the periorbital muscles is also effective but, because of potential complications, is considered only if botulinum toxin is ineffective. Sunglasses, particularly with FL-41 tinted lenses, help decrease the light sensitivity that may cause or accompany blepharospasm (4). Temporary relief can also be obtained by alleviating maneuvers such as touching the face, covering the eyes, singing, or yawning (5).