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Blepharospasm (Benign Essential Blepharospasm) (Essential Blepharospasm) Print E-mail

Dr. Kennedy Blepharospasm, aka benign essential blepharospasm and essential blepharospasm. Blepharospasm is "a chronic, unremitting, bilateral, variably progressive dysfunction of the nerve that controls the muscles around the eye." It presents as an uncontrollable, forcible closure of the eyelids. It can also affect only one eye but usually affects both eyes. Other muscles in the face may twitch as well, especially around the cheek and brow. Severe blepharospasm can cause the eyelids to be forcibly closed for a duration longer than the typical eye blink reflex thus disrupting vision. It is caused by abnormal nerve impulses to the eyelid muscles. There are different forms of blepharospasm:

  • Eyelid twitches or Tics
  • Benign Essential Blepharospasms (also called Essential Blepharospasm)
  • Hemifacial spasms or Meige's Syndrome

    The early symptoms are occasional, involuntary winking, blinking, or squinting of one or both eyes. It may also manifest itself as an increased difficulty in keeping the eyes open. Light sensitivity (photophobia) is a common occurrence with blepharospasm patients. As the condition progresses, the eyelid spasms increase in frequency and severity until they are continuous, leaving both eyelids tightly shut and the eyebrows pulled down. In some cases, only one eye is affected.

    The cause of blepharospasm is unknown. Studies indicate an area of the brain called the "basal ganglia" may be involved. Symptoms occur most frequently in persons in their 50s and 60s. Women are three times more likely to have the condition than men.

    There are three accepted treatments for blepharospasm. They are (1) the neurological approach, (2) the surgical approach, and (3) the use of the Botulinum toxin (Botox) injections:

    • In the neurological approach the doctor may prescribe medications or recommend biofeedback training. The medical approach to treatment has been limited primarily to drug therapy. Moderate success has been reported in controlling blepharospasm through the use of diazepam, levodopa, methyldopa, lithium, clonopine, lioresal, and tetrabenzine. These treatments are not always successful.
    • The surgical pproach have limited results with the need for frequent repeat procedures. Myectomy involves resection and removal of muscles in the upper eyelids and brow. Neurectomy involves resection and removal of the small facial branches of the orbicularis muscles. This procedure is rarely performed.
    • Botulinum Toxin (Botox) Injections generally present the best chance of success. The toxin is produced by the same bacteria responsible for a type of food poisoning called botulism when consumed in large amounts. The injection of very small amounts of the Botulinum toxin injected into the eyelid muscles is is quite safe and very effective in stopping eyelid spasm for up to several months. However, the effect is temporary, therefore periodic injections are required for control of blepharospasms. Botox injections are now the treatment of choice for blepharospasm. There can be side effects of Botulinum toxin injections such as drooping eyelid, double vision, or dryness of the eye. Fortunately, these side effects are not common and wear off with time.


The information in this article is not meant to be medical advice.�Treatment for a medical condition should come at the recommendation of your personal physician.

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