Blepharospasm is twitching or spasms of the eyelids. It may also cause dry eyes, increased blinking, or involuntary eye closure.
The exact cause of blepharospasm, also known as benign essential blepharospasm, is not fully understood. However, it may be related to genetic factors, blepharitis, keratoconjunctivitis, or Parkinson’s disease.
Treatment for blepharospasm is managed by an ophthalmologist or neurologist. It usually involves photochromic lenses, botulinum toxin injections, medications, or, in some cases, surgery.
Main symptoms
The main symptoms of blepharospasm are:
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Dry eyes
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Increased blinking
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Difficulty opening the eyes
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Involuntary eye closure
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Sensitivity to light
In addition, blepharospasm can also cause facial spasms, making the face appear to twitch. Eyelid ptosis may also occur, which is when the eyelid droops over the eye.
Blepharospasm typically affects both eyes at the same time. According to the National Eye Institute, symptoms can worsen over time and may make it difficult to keep the eyes open, which can significantly interfere with vision.
These symptoms can significantly impact daily life and may lead to psychological distress or depression.
Confirming a diagnosis
Blepharospasm is usually diagnosed by an ophthalmologist or neurologist based on a review of symptoms, their severity, medical history, and a physical eye exam.
The doctor may assess blinking patterns and reflexes during the exam, including tests such as Myerson’s sign, which involves gently tapping the forehead to observe blinking.
In most cases, additional testing is not needed. However, electromyography may be used in selected cases to evaluate the function of the orbicularis oculi muscle or to rule out other movement disorders.
Possible causes
The main causes of blepharospasm are:
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Family history of benign essential blepharospasm
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Past or current history of eye or nervous system diseases
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Eye strain from watching TV or using a computer or phone screen
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Stress or excessive fatigue
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Obsessive-compulsive disorder (OCD), depression, or anxiety
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Parkinson’s disease, multiple sclerosis, or stroke
Eye inflammation can also trigger blepharospasm, including inflammation of the eyelids (blepharitis), cornea, or conjunctiva (keratoconjunctivitis).
Main types
Blepharospasm can be classified into two different types:
1. Primary blepharospasm
Primary blepharospasm has no known cause and is not associated with other health conditions. It is also called idiopathic blepharospasm.
2. Secondary blepharospasm
Secondary blepharospasm occurs due to other health conditions, such as eye diseases, Parkinson’s disease, brain or facial trauma, or medication use, for example.
Treatment options
Blepharospasm treatment should be guided by an ophthalmologist or neurologist. The goal is to relieve symptoms, and treatment varies depending on the cause.
The main treatments for blepharospasm are:
1. Photochromic lenses
Photochromic lenses may be recommended by an ophthalmologist to reduce light sensitivity.
These special lenses darken in brighter environments and become clearer in darker environments, which helps reduce discomfort caused by intense light.
2. Botulinum toxin injections
According to the American Academy of Ophthalmology, botulinum toxin (Botox) injections are the first-line and most common treatment for benign essential blepharospasm. They relax the orbicularis oculi muscles, helping to prevent eyelid spasms and twitching.
This injection is given by a doctor and usually lasts about 3 to 6 months, meaning repeat applications are needed.
3. Medications
Oral medications, such as muscle relaxants, anti-anxiety medications, antidepressants, anticholinergics, or antiparkinsonian medications, may also be recommended by an ophthalmologist or neurologist to help relieve symptoms.
However, these medications are generally used to complement treatment with botulinum toxin injections, or when symptoms do not improve with Botox.
4. Surgery
Surgery for blepharospasm may be recommended to reduce the frequency of eyelid spasms and improve eyelid function when other treatments have not relieved symptoms.
The main surgery for blepharospasm is myectomy, which may involve removing some muscles and nerves from the eyelid.
How long can blepharospasm last?
Blepharospasm is a chronic condition with no cure and may last a lifetime.
However, symptoms can be relieved with treatment recommended by a doctor, helping improve quality of life.