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Blepharospasm: Causes, Symptoms & Treatment

Blepharospasm is an involuntary eyelid spasm caused by uncontrolled muscle contractions around the eye. It can severely affect daily life and vision.

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Things worth knowing about "Blepharospasm"

Blepharospasm is an involuntary eyelid spasm caused by uncontrolled muscle contractions around the eye. It can severely affect daily life and vision.

What is Blepharospasm?

Blepharospasm is an involuntary, repetitive spasm of the eyelids caused by uncontrolled contractions of the orbicularis oculi muscle, which surrounds the eye. Affected individuals cannot consciously control or stop the closing of their eyelids. In severe cases, blepharospasm can lead to functional blindness, as the eyes remain closed for extended periods despite normal visual function.

The condition belongs to the group of focal dystonias – neurological movement disorders in which specific muscle groups are persistently overactive. Blepharospasm most commonly develops in adulthood, typically between the ages of 50 and 70, and affects women slightly more often than men.

Causes

The exact cause of primary blepharospasm is not yet fully understood. It is believed that dysfunction of the basal ganglia in the brain plays a central role. These brain structures are responsible for coordinating and controlling movement.

Primary (idiopathic) blepharospasm: No identifiable underlying condition; likely a combination of genetic predisposition and environmental factors.
Secondary blepharospasm: Triggered by other conditions such as Parkinson's disease, multiple sclerosis, brain injuries, or chronic eye conditions like dry eye syndrome.
Medication-induced: Certain medications, particularly antipsychotics and dopamine antagonists, can cause blepharospasm as a side effect.

Symptoms

Symptoms typically develop gradually and increase in intensity over time:

Increased blinking, often the first sign
Involuntary eyelid spasms that cannot be suppressed
Prolonged involuntary closure of both eyes
Light sensitivity (photophobia)
Sensation of dry or burning eyes
In severe cases: functional blindness due to persistently closed eyelids

Symptoms can be worsened by stress, bright light, screen use, and fatigue. Spasms typically disappear during sleep or deep relaxation.

Diagnosis

Blepharospasm is primarily diagnosed clinically, based on the observation of characteristic symptoms. A standard diagnostic workup includes:

Detailed medical history and neurological examination
Exclusion of secondary causes through ophthalmological examination and, if necessary, brain imaging (MRI)
Assessment of disease severity using clinical scales such as the Jankovic Rating Scale
Differential diagnosis from hemifacial spasm, tics, or myokymia

Treatment

Botulinum Toxin Injections

The most effective and widely used treatment is the injection of botulinum toxin (Botox) into the affected eyelid muscles. The toxin inhibits nerve signal transmission to the muscles, relaxing the involuntary contractions. The effect typically lasts 3 to 4 months, after which repeat injections are necessary. This therapy is considered the gold standard and is well tolerated by most patients.

Oral Medications

In some cases, oral medications may be used, including:

Anticholinergics (e.g., trihexyphenidyl): Reduction of muscle activity
Benzodiazepines (e.g., clonazepam): Muscle relaxation and anxiety reduction
Baclofen: Muscle relaxant used in dystonic disorders

Surgical Treatment

In treatment-resistant cases, a myectomy may be considered – a surgical procedure in which parts of the orbicularis oculi muscle are removed. Deep brain stimulation (DBS) is also an option in exceptional cases.

Supportive Measures

Tinted glasses to reduce light sensitivity
Avoiding triggers such as stress and screen light
Psychological support when quality of life is severely affected

Prognosis

Blepharospasm is a chronic condition that typically worsens without treatment. However, with regular botulinum toxin injections, the majority of patients can lead a largely normal life. A complete cure is currently not possible, but symptoms can be effectively controlled in most cases.

References

Hallett M. et al. - Blepharospasm: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 2001.
Albanese A. et al. - Phenomenology and classification of dystonia: a consensus update. Movement Disorders, 2013.
Bhidayasiri R., Cardoso F., Truong D.D. - Botulinum toxin in blepharospasm and oromandibular dystonia: comparing different botulinum toxin preparations. European Journal of Neurology, 2006.

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