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Blepharospasm means involuntary twitching, blinking or closure of the eyelids. There can be various reasons for this disorder. Some of the disorders and conditions associated with blepharospasm include dry eyes and Tourette’s syndrome. However, most cases occur spontaneously with no apparent cause.
Men and women of any age can be affected, but middle-aged and older women appear to be particularly susceptible. In severe cases, the person is rendered blind because the muscular spasms force the eyelids shut, sometimes for hours. The person with blepharospasm may give up sports, driving or socialising for fear of ‘losing’ their eyesight to a muscular spasm. There is no cure. Treatment includes paralysing the eyelid muscles with injections of the botulinum toxin or surgery to remove the muscles. Blepharospasm is also known as benign essential blepharospasm (BEB).
Causes
The cause of blepharospasm is unknown, but abnormalities in the way the brain is working are thought to be involved. One theory suggests that chemical messages fail to pass from one nerve cell to another in the brain’s movement control centres (the basal ganglia, located at the brain’s base). No one knows what causes the dysfunction or damage.
Occasionally, more than one family member is affected by blepharospasm, which suggests there may be a genetic factor involved. In many cases, the symptoms of ‘dry eye’ either precede blepharospasm or start at the same time, but the significance of this isn’t known.
Symptoms
A person with blepharospasm may blink, squint, wink or twitch one or both eyes, or have difficulties keeping their eyes open. The spasms become increasingly more pronounced and frequent as time goes by. The progression of symptoms includes:
- Spasms in response to particular triggers, such as fatigue or bright lights
- Spasms occurring more frequently during the day, whether the triggers are present or not
- Spasms forcing the eyelids shut for hours at a time – spasms also pull the eyebrows down towards the eyes.
Different classifications
Blepharospasms are often graded according to their severity, which includes:
- Tics and twitches – many people experience brief bouts of eyelid twitches when they are tired. The muscle contractions are so small that often the twitch can only be felt but not seen.
- Blepharospasm – chronic involuntary spasms of the eyelid muscles.
- Meige’s syndrome – the person has involuntary and repetitive movements of the mouth and tongue as well as the eyelids. The person’s mouth may open and close, their lips purse and their tongue poke in and out. Meige’s syndrome is also known as oromandibular dystonia.
Diagnosis
There is no particular test for blepharospasm. Diagnosis relies on physical examination, medical history and ruling out other possible causes.
Blepharospasm is often misdiagnosed or not diagnosed at all, because it shares similar characteristics with a range of other problems including blepharitis (inflammation of the eyelids) and ptosis (droopiness) of the eyelids. Particular drugs such as antipsychotic medications and drugs to treat Parkinson’s disease can cause similar symptoms to blepharospasm.
Treatment
Treatment for blepharospasm includes:
Stress management – symptoms tend to worsen in times of emotional stress. Learning stress management techniques and joining a support group can be helpful.
- Medication – drugs such as lithium and diazepam (Valium) are sometimes used, but the success rate varies. There is no standard treatment regime either, because a particular drug may bring relief to one patient but not another.
- Botulinum toxin (botox) injections – botulinum toxin is made by the bacteria Clostridium botulinum. When injected, the toxin disrupts nerve messages to muscles and causes paralysis. Generally, multiple injections are given both above and below the eye. It takes between one and four days for the paralysis to begin. The complete effect usually takes about a week. The treatment often lasts up to four months. Botox injections work for about 90 per cent of patients. Common but temporary side effects include drooping eyelids (ptosis) and double vision. Short-term blurry vision is common. This is because the tear film on the cornea, the outer covering of the eyes, dries up. Special drops can help to relieve this symptom.
- Surgery – the patient undergoes a myectomy, which is an operation involving the removal of some (or all) of the eyelid and eyebrow muscles responsible for squinting. This procedure is usually performed after botox therapy has failed. Repeat operations may be needed in some cases. Myectomy improves the symptoms of blepharospasm in up to 80 per cent of patients.
Where to get help
- Your doctor
- Ophthalmologist
- The Royal Victorian Eye and Ear Hospital Tel. (03) 9929 8666
- Blepharospasm Support Group, The Royal Victorian Eye and Ear Hospital Public Relations Department Tel. (03) 9929 8536
Things to remember
- Blepharospasm means involuntary twitching, blinking or closure of the eyelids resulting from any cause.
- Blepharospasm is often misdiagnosed or not diagnosed at all, because it shares similar characteristics with a range of other problems.
- Treatment includes paralysing the eyelid muscles with injections of the botulinum toxin, or surgery to remove the muscles.
You might also be interested in:
Eye disorders - focusing problems.
Eye disorders - some common problems.
Eyes explained.
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