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Blepharospasm

Blepharospasm Treatment in Delhi, India

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Overview

Blepharospasm is a neurological disorder that affects the muscles of the eyes. These are the muscles that control the movement of the eyelids. The onset of blepharospasm begins with twitching of the muscles and can even progress to the closing of the eyes. Benign Essential Blepharospasm is a bilateral condition and a type of focal dystonia characterised by involuntary movement of the eye muscles such as orbicularis oculi, procerus, and corrugator superciliaris muscles.

Blepharospasm is a rare disorder, and very few cases of it are recorded every year. The exact reason for blepharospasm is still unknown (idiopathic). People are speculating the reason is an abnormal electrical activity in the basal ganglia that results in uncontrollable eye movements.

People in the middle age range are more susceptible to developing blepharospasm. Dry eyes are also susceptible to developing it, but dry eyes are the symptom of many other diseases as well, so it is the duty of the doctor to pinpoint and diagnose the exact problem. In advanced cases of blepharospasm, the patient is not able to open the eyes properly or keep the eyes open for a long time.

Blepharospasm Signs and Symptoms

Blepharospasm shows the following signs and symptoms, which may be mild to severe-

  • Regular blinking
  • Blinking is intense during the day
  • No blinking compulsion is observed while sleeping.
  • Dry eyes
  • Narrowing of the eyes
  • Continuous blinking
  • Tired and irritated eyes
  • Facial grimacing as in Meige syndrome
  • Tics or cogwheeling of the neck
  • Extremities in extrapyramidal disease states
  • Photophobia (in reflex Blepharospasm)

Ocular signs of blepharitis and surface disease can be observed.

Blepharospasm Diagnosis

There are no laboratory tests needed for diagnosing blepharospasm. However, the doctor or the physician will ask about the medical history of the patient and run some physical tests. This is a very rare disorder; therefore, seeking medical help is required to reduce its effects. BEB (Benign Essential​ Blepharospasm) is diagnosed clinically and based on exclusions and rule-out principles. Neuroimaging tests are not effective in this case.

Differential Blepharospasm Diagnosis

  • Eyelid myokymia
  • Aberrant reinnervation/synkinesis
  • Secondary to ocular irritation (photophobia, blepharitis, intraocular inflammation, dry eyes, etc.)
  • Focal seizures
  • Secondary to meningeal irritation
  • Infections (viral encephalitis, Reye's syndrome, AIDS, tuberculosis, tetanus)
  • Tardive dyskinesia
  • Cerebral palsy
  • Meige syndrome
  • Hemifacial spasm
  • A systemic disease symptom associated with lesions of the brainstem and basal ganglia (Parkinson's, Huntington's, Wilson's)
  • Facial tics

Blepharospasm Treatment

Given below are the treatment options for blepharospasm-

  • The first-line treatment for Benign Essential Blepharospasm is periodically injecting botulinum toxin into the eyelid protractor muscles such as orbicularis oculi, corrugator supercilii, and procerus muscles.
  • For the second line of treatment, medications can be used to reduce spasms.
  • Acupuncture and herbal treatment may be helpful.
  • For secondary blepharospasm, treatment of the underlying issues is recommended.
  • For dry eyes and ocular irritation, artificial tears should be recommended.
  • For reducing blepharitis, baby shampoos or non-irritating soaps must be used to avoid exaggerating blepharospasm. 
  • For diminishing photophobic irritation, dark sunglasses (FL-41 tinted) should be used to minimise the effect of the triggering factor. 
  • The surgical treatment for blepharospasm includes myectomy, a surgical procedure to remove part of the eyeball muscles which are overactive.

Blepharospasm Complications

The complications of blepharospasm are related to Botulinum toxin injections, such as:

  • Bruising
  • Blepharoptosis
  • Ectropion
  • Epiphora
  • Diplopia
  • Lagophthalmos
  • Corneal exposure
  • The toxin is transient and is transferred to the adjacent muscles.

The central portion of the pretarsal orbicularis is neglected, so the chances of the appearance of ptosis are high.

Blepharospasm Risk Factors

  • People who are on medications for Parkinson's are prone to blepharospasm.
  • Individuals who have General dystonia are also prone to developing blepharospasm.
  • Tardive dyskinesia
  • Wilson disease
  • Meige syndrome

Reviewed & Updated On

Reviewed by Dr. Sanjay Saxena, Senior Director & HOD, Neurosciences, Neurology on 22-Mar-2023.

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