Definition & Overview

Blepharospasm is a medical condition characterized by excessive blinking. The muscles around the eyes may experience twitching or spasms. In some cases, the muscles around the mouth may also be affected as well. If left untreated, the condition will likely result in vision problems or even functional blindness as the eyelids will refuse to open.

Although blepharospasm is known to develop spontaneously, it usually begins with mild symptoms. Patients will initially experience eye twitches when exposed to certain conditions, such as sunlight, stress, or reading. The twitching will then develop into blinking from time to time under those conditions. As the condition progresses, the blinking becomes more severe even when not exposed to certain triggers. In the late stages, the eyelids may no longer open for a few hours or an extended period.

When diagnosing blepharospasm, doctors will usually not be able to determine the exact cause of the condition. Some believe it is a problem with the transmittal of signals between cells in the brain. Some say it has something to do with being exposed to certain environmental conditions, medications, or chemicals.

Cause of Condition

The exact cause of blepharospasm, in most cases, is unknown. However, doctors do know that the condition is benign, which means that it does not spread to other parts of the body, although facial muscles may also be affected.

Everybody, regardless of age, gender, or race, is at risk of developing the condition. People between the ages 40 and 65 have a higher risk of developing it than those in the lower age group. The condition also occurs more often among women than men.

It has also been noticed that many cases actually begin during childhood, but gets more severe as the person ages.

The exact cause of blepharospasm may still need to be determined, but scientists have noticed that the problem usually arises when there is an abnormal function of the basal ganglion, which is located at the base of the forebrain. Scientists are still researching on the exact causes of the abnormality. It is possible that the condition could be inherited as well.

Key Symptoms

The primary symptom of the condition is twitching of the eyelid muscles and the muscles surrounding the eyes. As the condition progresses, this twitching can also affect the muscles around the lips.

In some people, sunlight, emotional stress, and fatigue can trigger the twitching. For instance, if a person is reading, or when he or she has emotional problems, he or she might experience eye irritation, which will cause the eyelids to twitch.

The twitching of the muscles will often progress into uncontrolled blinking. Initially, the blinking may simply seem like an automated response to a certain condition. Patients often think of it as an unconscious action or mannerism that they do not need to worry about.

Unfortunately, as time goes on, the blinking becomes more frequent and no longer requires a trigger. It can also include twitching of other facial muscles. The only time that the blinking and twitching would stop is when a person is focusing on a certain task or sleeping.

Who to See & Types of Treatment Available

Blinking uncontrollably can be annoying, not to mention embarrassing. Since the condition involves the eyes, patients will normally consult an ophthalmologist.

At this stage, you should be aware that because the exact cause of the condition has not been discovered, a cure is not available as well. However, there are treatment options that are designed to manage the symptoms. Most treatments are only temporary so patients will need to see their ophthalmologist on a periodic basis to receive treatment.

The primary treatment is to inject a muscle relaxant, such as botulinum toxin, or BOTOX. The drug is injected directly into the eyelids to paralyze the muscles. The effects are only temporary. How long they last will differ from person to person. Some people may experience the effects for only a few weeks, while it can last for months in others.

There are also oral medications available, but the results are not predictable. Even if they are effective, the effects will only last for a short time.

A highly effective treatment method is a minor surgical procedure called myectomy, which removes some of the nerves and muscles in the eyelid. It is effective in almost 85% of people.

Other than standard medical practices, some people seek relief from the condition through alternative medicines, such as acupuncture and hypnosis. The success of these forms of treatment varies widely and there is no scientific evidence of their effectiveness.

It’s imperative that a person with blepharospasm receives treatment as soon as possible. Leaving the condition untreated could lead to serious complications, such as functional blindness. However, you should also be aware that the available forms of treatment also have undesirable effects.

Some people experience the loss of facial expression due to the temporary paralysis of facial muscles. Others may experience cosmetic deformities, such as a malposition of the eyelids.

References:

  • Faucett DC. Essential blepharospasm. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis, MO: Mosby Elsevier; 2008:chap 12.8.

  • Prasad S, Galetta SL. The facial nerve. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 2, chap 8.

  • Yanoff M, Cameron D. Diseases of the visual system. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 431.

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