Blepharospasm is part of dystonias, abnormal postures and movements. It is the involuntary and repetitive spasmodic contraction of the eyelid due to the contraction of the circular muscle that surrounds the eye (orbicularis muscle). It’s quite annoying. Blepharospasm disappears when the patient is sleeping. It usually affects people over 50 years of age and occurs more frequently in women. If it begins in childhood, it frequently spreads to different muscle groups with the risk of producing abnormal postures.
Once spasms start, they may come on and off for a few days and then go away. Other times it starts gradually and increases. Then they disappear. Most people experience this type of blepharospasm occasionally and find it very bothersome. In most cases, you don’t even notice when the contraction has stopped. Sometimes it lasts over time without being able to locate the cause. It can also cause complete closure of the eyelids, causing visual problems.
Blepharospasm is also called eyelid spasm, eye twitching, eyelid twitching, or myokymia.
Causes of blepharospasm
Neurological, side effects of medications, lack of lubrication of the ocular surface
The following are suggested as possible causes of blepharospasm:
– A neurological disorder or Meige syndrome that causes irregular contractions on one side of the lower part of the face, usually in the jaw and tongue and around the eyes.
– Side effects of certain medications used for migraine headaches.
– Lack of lubrication of the ocular surface which causes increased activity of the eyelid when trying to distribute the tear.
– Irritation of the cornea or conjunctiva.
– Fatigue and/or stress.
– Caffeine consumption.
– Alcoholism.
Symptoms of blepharospasm
Involuntary eye closing or uncontrollable blinking
Signs of blepharospasm are:
– Uncontrollable flickering.
– Involuntary closing of the eyes.
– Inability to open the eyes.
– Drooping of the upper eyelid.
– Difficulty driving, reading, watching television or carrying out activities of daily living.
– Photosensitivity.
If the signs last more than a week, you should see a specialist, especially if the contractions close the eyelid completely or involve parts of the face. It is also a cause for urgent attention if there is redness, swelling or discharge from an eye.
Diagnosis of blepharospasm
Neurological
Blepharospasm usually leads to an ophthalmologist’s consultation, but it also requires a neurological examination with tests determined by both specialists. X-rays, magnetic resonance imaging (MRI) and computed tomography (CT) will be requested to detect possible injuries or neurological alterations.
Blepharospasm treatment and medication
botulinum toxin
The first recommendation in the treatment of blepharospasm is to have adequate rest and avoid stimulants such as caffeine. In addition, anxiolytics will probably be prescribed. However, the standard treatment is injections of botulinum toxin type A into the muscles that open the eyelid (palpebral muscles). The injections usually have to be repeated. Surgical cuts in part of the facial muscles (periorbital muscles) may also be effective if botulinum toxin injections fail.
Wearing sunglasses to reduce photosensitivity and exercises such as touching your face, covering your eyes, singing or yawning can also help.
Prevention of blepharospasm
Early detection
Blepharospasm cannot be prevented but early detection is key. In many cases it is associated with an ophthalmological problem but the neurological cause is more likely.
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