What is blepharospasm?

Blepharospasm is forceful, uncontrollable closing of the eyelids. Often it affects both eyes, but it can affect only one. As the condition worsens, the blinking or winking occurs more often. The eyelids can be closed for longer than a normal blinking reflex, which may cause vision problems.

Sometimes the condition is called essential blepharospasm. Essential means that the problem is not caused by any other disease.

Blepharospasm is quite different from the mild spasms of the lid that sometimes occur with stress, use of caffeine, or insufficient sleep and do not affect vision.

How does it occur?

The exact cause of blepharospasm is not known. Most experts believe that the basal ganglion in the brain does not work normally. The basal ganglion helps coordinate movement of the muscles. Also, the nerves in or near this area of the brain may not work normally. This problem may run in families.

Medicines, such as those used to treat Parkinson’s disease, may cause this problem. Other factors may play a part in this condition, including:

• stress or fatigue
• dry eyes (not enough normal moisture in your eyes).

In the past, blepharospasm was thought to be a psychiatric problem, but now we know that is not true.

What are the symptoms?

The symptoms are:

• winking, blinking, or squinting that you cannot control
• trouble keeping your eyes open
• sensitivity to light.

How is it diagnosed?

Your doctor will ask about your symptoms and examine your eyes.

How is Blepharospasm treated?

The main forms of treatment are:

• injection of a medicine (Botox)
• medicines taken by mouth
• surgery
• stress management

Very small amounts of botulinum toxin A (botox), made from the bacteria Clostridium botulinum (botox), can be injected into the muscle that closes the eyelids. This Botox stops the muscle spasms for several months. These Botox injections will need to be repeated about every 3 months.

Some medicines cause spasms. Stopping these medicines or reducing their dosage may stop the spasms.

Finally, stress management and coping techniques may help lessen the spasms and help you feel more comfortable in social situations. Bright light may make spasms worse, so wearing dark glasses may reduce some spasms. Also, dark glasses make the problem less noticeable to others. Support from support groups, family, and friends can be reassuring and may help you continue to be as active as you want.

How can it be prevented?

Usually blepharospasm cannot be prevented. If you have dry eyes, getting treatment for them may help prevent blepharospasm.