Blepharospasm

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Blepharospasm

What is blepharospasm?

Blepharospasm is a condition characterized by repetitive and involuntary spasms of the orbicularis muscle (the muscle around the eye), leading to abnormal movements or positions of the eyelids, a phenomenon known as dystonia.

  • Essential or primary blepharospasm is usually bilateral (affecting both eyes) and may be accompanied by involuntary movements of the neck, face, or mouth, which typically subside when the patient is asleep.
  • The condition typically progresses gradually, with the frequency and intensity of spasms increasing over time.
  • The forced closure of the eyelids can cause visual disturbances and make it difficult for individuals to keep their eyes open.

What causes it?

Blepharospasm is one of the most common facial dystonias, which are disorders involving abnormal muscle contractions. The causes include:

  • Neurological disturbance in the central nervous system.
  • Side effects of certain medications.
  • Lack of lubrication on the ocular surface, which leads to increased eyelid activity as the body attempts to distribute insufficient or poor-quality tears.
  • Hemifacial spasm, a related disorder that causes involuntary movements on one side of the face. Hemifacial spasm is not a dystonia but can also affect the eye, often due to facial nerve compression by an artery or trauma.

In many cases, blepharospasm may be misdiagnosed or misunderstood, especially if the symptoms are confused with other ocular conditions or if it is associated with a neurological factor.

How can it be prevented?

Blepharospasm cannot be prevented. However, early diagnosis is crucial. Since many people may not be aware they have the condition, it often goes unnoticed or is underestimated. If the condition begins in childhood, it can spread to other muscle groups over time.

Early detection and treatment can help prevent complications associated with the repetitive abnormal muscle contractions.

Symptoms

  • Uncontrollable blinking.
  • Forced closure of the eyes.
  • In severe cases, reduced vision due to inability to open the eyes properly.

Associated treatments

Treatment for blepharospasm aims to reduce muscle spasms and improve the patient's quality of life. Common treatments include:

  1. Ocular protection:

    • Wearing sunglasses to reduce light sensitivity and protect the eyes.
    • Eye drops to help with lubrication and reduce discomfort.

  2. Injectables:

    • Botulinum toxin injections (Botox) are commonly used to temporarily relax the affected muscles and prevent spasms. This treatment is 90% effective in most cases.

  3. Surgery:

    • In severe cases, myectomy (removal of part or all of the orbicularis muscle and the depressor muscle) may be required. This procedure aims to prevent the eyelids from involuntarily closing.

  4. Neuromodulators:

    • Other injectable neuromodulators may be used to reduce spasm intensity.

Conclusion

Blepharospasm is a neurological condition characterized by involuntary eyelid spasms that can severely impact vision and quality of life. Early diagnosis and treatment are essential in managing the condition, and various therapies, including injections, ocular protection, and in some cases surgery, are available to help control symptoms.