Blepharospasm

What is blepharospasm?

Blepharospasm is forceful, involuntary closing of the eyelids. Often it affects both eyes, but it can affect only one. As the condition worsens, the blinking or winking occurs more often. The eyelids can be closed for longer than a normal blinking reflex, which may cause vision problems.

Sometimes the condition related to another problem. However, in most cases, the condition is not caused by any other disease and is called essential blepharospasm. Blepharospasm may also involve the forehead or the muscles around the mouth.

Blepharospasm is quite different from the mild twitches of the lid that sometimes occur with stress, use of caffeine, or lack of sleep and do not affect vision.

How does it occur?

The exact cause of blepharospasm is not known. Many experts believe that the condition is related to a problem in a part of the brain that coordinates muscle movement (the part of the brain called the basal ganglion). Blepharospasm sometimes seems to run in families.

Medicines, such as those used to treat Parkinson's disease, may cause this problem. Other factors may play a part in this condition, including:

• stress or fatigue
• dry eyes (not enough normal moisture in your eyes)

In the past, blepharospasm was thought to be a psychiatric problem, but now we know that is not true.

What are the symptoms?

The symptoms are:

• winking, blinking, or squinting that you cannot control
• trouble keeping your eyes open

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine your eyes.

How is it treated?

The main forms of treatment are:

• injection of a medicine
• medicines taken by mouth
• surgery

Very small amounts of botulinum toxin A can be injected into the muscles that close the eyelids. This may weaken or stop the muscle spasms for several months. The shots almost always need to be repeated about every 3 months, although the effects of the shots last longer than this for some people.

Medicines taken by mouth may also help to control the muscle spasms. But often what works for one person may not work for another. Also, the benefits may not last very long. You will need to work closely with your provider to find out what medicine and dosage work for you. Sometimes researchers find new medicines that may help. Or they find that medicines used for other diseases provide relief for some people. Ask your provider about the latest research on medicines to treat blepharospasm.

Some medicines cause spasms. Stopping these medicines or reducing their dosage may stop the spasms.

If neither the shots nor the medicines taken by mouth stop the spasms, you may need surgery to remove some of the muscles that close the eyelids. This surgery (called myectomy) can weaken or stop the spasms. Myectomy can result in pain, scarring, and may not correct the problem. Therefore, myectomy is only done as a last resort.

Bright light may make spasms worse, so wearing dark glasses may reduce some spasms. Also, dark glasses make the problem less noticeable to others.

Support from support groups, family, and friends can be reassuring and may help you continue to be as active as you want.