Eye Health Central

What is Blepharospasm

What Is Blepharospasm?

Many people probably experience blepharospasm without ever realizing it or paying much attention to it. The name is derived from the Greek word blepharon, meaning eyelid, and spasmos, meaning spasm, or uncontrolled contraction. Simply put, it is an abnormal and uncontrollable twitch of the eyelid. The twitch may go completely unnoticed, or only last a few moments before ceasing. Many people rub their eyes and don't think twice about it. It's not commonly associated with any other noteworthy conditions, and doesn't usually indicate any serious medical issue that needs to be tended to or diagnosed. However for those that experience it frequently, it can be a mild nuisance, and it can potentially interfere with normal day to day life.

What Are The Causes Of Blepharospasm?

Only a few direct causes of blepharospasm have been identified so far, but most instances of the condition don't have any clear or attributable cause. It is a common side effect of stress or tiredness. Many sufferers of blepharospasm have a history of dry eyes, or light sensitivity, while some might have never experienced either eye problem before developing blepharospasm.

Several drugs intended to treat other, unrelated conditions can trigger blepharospasm, such as those used to treat Parkinson's disease. Hormone treatments can have a similar effect, such as estrogen-replacement therapy, which is commonly used for women going through menopause. Blepharospasm can also be caused by withdrawal from, or extended use of benzodiazepines.

The condition has also been linked to an abnormal functioning of certain areas within the brain, as well as the development and progression of multiple sclerosis

What Are The Symptoms Of Blepharospasm?

Anyone experiencing one or more of the following symptoms may be affected by blepharospasm. It's recommended to speak with your doctor if you feel that it's a problem that's affecting you and your day to day life.

  • Excessive blinking or spasming of the eyes
  • Uncontrollable contractions or twitches of the eye muscles, sometimes stretching outward to other nearby muscles in the face
  • Eyes that feel dry
  • Sensitivity to bright light

For a majority of people that experience the condition, the symptoms don't last long, perhaps only a few minutes, hours, or days before disappearing. However, in rare cases the twitching can be persistent, lasting much longer, and perhaps causing lifelong challenges. In those rare situations the symptoms can be severe enough to result in functional blindness, due to the inability to open the eyelid or focus the eye. Eyelids may open and close repeatedly, or may even feel like they are clamping shut, and unable to open. People with injuries or other causes of pain to their face or eyes can experience reflex blepharospasm, which is a reaction to the pain itself, and should subside when the pain does.

Are There Different Types Of Blepharospasm?

There are actually two types of blepharospasm, essential and reflexive, but both exhibit nearly the exact same symptoms. The primary difference between them is that one is an issue in and of itself, while the other is a symptom of another problem, with its own unrelated cause.

Essential blepharospasm is a neurological movement disorder that involves the involuntary and sustained contractions of the muscles near and around the eyes. The cause of this type of blepharospasm is not clear, but is thought to be triggered by a number of factors, such as fatigue, stress, or even a foreign substance or irritant that's affecting the eye.

Reflexive blepharospasm is merely a reaction to moderate to severe pain or discomfort near to the eyes, usually somewhere close to the eyes, nose, or mouth.

How Is Blepharospasm Treated?

Neither of these conditions have an established or effective cure, but there are several options available for treatment. Since blepharospasm severely impacts so few people, despite appearing in so many, the treatments are not always recommended, and are likely unnecessary for most cases. The three most common treatments are:

  • Drug Therapy - Anticholinergics, tranquillizing drugs, and botulinum toxin are the most commonly prescribed therapeutic options, but none of them are guaranteed to provide positive results. In fact, their effects can be unpredictable, and sometimes less than ideal. In some cases they are not only ineffective, but the side effects are worse than the blepharospasm they are intended to treat. Anyone that chooses to treat this condition with drugs should expect a challenging course of trial and error before settling on an effective treatment, which may not be possible at all.
  • Botulinum Toxin Injections – Popularly known as Botox, this derivative of botulism is effective at inducing localized partial paralysis, which can stop the muscled around the eyes from twitching. The effects of the injections are almost immediate, and the patients are typically able to live a normal life with the drug remains effective. This is by far the most preferred method of treatment for chronic blepharospasm, but it is not a permanent cure. The treatments only last several months, and will need to be repeated as long as the symptoms of the condition persist. Some patients may find that over time, repeated injections can result in a reduction in effectiveness, and may eventually need to seek out another form of treatment.
  • Surgery – Those that don't respond well to medication or botulinum toxin injection are left with surgical therapy as the only remaining treatment option. The most effective surgical treatment is known as protractor myectomy, which involves the removal of muscles responsible for eyelid closure. This is only used in the most extreme cases of blepharospasm, where every other available treatment option has been exhausted.

Author: John Dreyer Optometrist Bsc(Hons), MCOPTOM, DipCLP
Created: 25 Aug 2016, Last modified: 4 Mar 2020