Blepharospasm is a condition in which there is a spasm of the eyelids in one or both eyes. The spasm cannot be influenced by the affected person.
What is blepharospasm?
Blepharospasm represents a voluntary spasm of the eyelids. It can occur on only one side of the eye or on both sides. Blepharospasm represents an arbitrary spasm of the eyelids. It can occur on one side of the eye or on both sides. The eyelid spasm is uncontrollable by the patient and is primarily seen in the orbicularis oculi muscle (eye ring muscle) as well as some adjacent muscles. Blepharospasm has a significant impact on the facial expressions of affected individuals. Three different types of blepharospasm must be distinguished: classic blepharospasm, tonic blepharospasm, and eyelid opening inhibition type. Classic blepharospasm represents a clonic eyelid spasm that occurs repeatedly, whereas tonic eyelid spasm is a continuous contraction. This results in a persistent narrowing of the palpebral fissure. Eyelid opening inhibition type is when the contraction is not on the eye ring muscle, but on the forehead muscle. There is a disturbance of the eye opening. Blepharospasm is one of the rare diseases. In Europe, three or four out of 100,000 people suffer from it. It is most often seen in women of middle or older age.
Causes
Blepharospasm results from spasm of the eyelid muscle. There is a differentiation between a primary and a secondary form. For the primary form, also called essential blepharospasm, no cause has yet been found. The only known cause is a disturbance in the interaction of different chemical substances within the basal ganglia of the brain. However, it has still not been possible to clarify what triggers these disturbances. In addition, external factors or the psyche also play a role. In many patients, for example, the spasm occurs after emotional stress. If the affected person rests, the symptoms subside again. But bright light, walking or drafts also sometimes trigger eyelid spasm. The secondary form is called symptomatic blepharospasm and is caused by certain diseases or disorders. These are diseases of the eyes or nerves, or damage to the central nervous system. However, the primary form is more common than secondary blepharospasm. In idiopathic blepharospasm, the cause of which is unknown, the affected person suffers from eyelid spasm on both sides of the eye. It usually starts initially with excessive blinking. Emotional stress, fatigue and bright light stimuli are considered typical triggers. As the eyelid spasm progresses, the symptoms intensify. In some cases, they are so intense that the eyes close for several hours. At night, the symptoms usually subside. In the morning, the symptoms are considerably less pronounced than in the evening hours.
Diseases with this symptom
- Corneal inflammation
- Ataxia
- Spasticity
- Eye migraine
- Dystonia
- Eye diseases
- Botulism
- Ptosis
- Conjunctivitis
- Eyelid rim inflammation
- Migraine
- Ectropion
Diagnosis and course of the disease
If blepharospasm is suspected, a physician should be consulted. A neurologist is considered the best place to start. This is the best way for him or her to assess and treat eyelid spasm. In contrast, ophthalmologists do not always notice a blepharospasm on initial examination. The doctor first looks at the patient’s medical history. He inquires about how long the symptoms have existed and whether any underlying diseases are present. During the subsequent examination of the eyes, he determines the blinking frequency. Normally, this is 10 to 20 times per minute. If the patient suffers from blepharospasm, blinking occurs at least 27 times per minute. Electromyography (EMG) is possible to measure the electrical activity of the eye ring muscle and other muscles. To determine the causes of secondary blepharospasm, magnetic resonance imaging (MRI) may be used.It is also important to exclude other causes that trigger eyelid spasm. Blepharospasm can have a significant impact on the quality of life of those affected, which in turn has negative consequences for the psyche. In addition, functional blindness is possible. In principle, however, eyelid spasm can be treated well.
Complications
Blepharospasm and the therapies used to treat eyelid disease can cause a number of complications. The disease itself sometimes leads to severe pain and spasms around the eyes, which become more intense over time and greatly increase the suffering for those affected. The dystonic movement disorders lead to cramps and pain in the muscles, injuries or spasms also occur and in turn bring a number of complications. In the worst case, blepharospasm leads to a persistent narrowing of the eyelid and ultimately to functional blindness. The psychological burden for those affected is usually just as great, which is why complications are not uncommon here either. In the course of therapeutic measures, a wide variety of complications can occur, depending on the treatment. Treatment with botulinum toxin, for example, typically leads to increased lacrimation and even diplopia, and can also cause headaches and sensitivity to light. Depending on the constitution and age of the patient, the formation of hematomas accompanied by local pain is also possible. The most common side effects of the anticholinergics used include forgetfulness, constipation, dry mouth, and blurred vision. If blepharospasm therapy fails, these symptoms may worsen, depending on the drug used and the patient’s medical history. Because of the potential complications, comprehensive therapy and neurologic follow-up of symptoms are necessary.
When should you see a doctor?
Blepharospasm refers to a spasm of the eyelids. In this case, the eyelid spasm can occur in one or both eyes. The eye ring muscle and a few of its neighboring muscles are mainly responsible. Affected individuals cannot control their blepharospasm. Since the phenomenon severely affects their facial expressions and thus their communication with other people, blepharospasm is not only a physical problem, but also a psychological one. To make matters worse, blepharospasm is an extremely rare condition that is unknown to most people. What is striking about blepharospasm is its prevalence in middle-aged and older women. When blepharospasm occurs, it is not an ophthalmologist who should be consulted, but a neurologist. He is more familiar with this eye disease than an ophthalmologist, has the appropriate diagnostic instruments at hand and can also better treat a blepharospasm. For example, electromyography (EMG) is used to measure the electrical activity of the eye ring muscle and neighboring muscles, as well as magnetic resonance imaging (MRI), which is already familiar to many patients from other examinations. Administration of botulinum toxin – also known as Botox – can also be used by neurologists to treat blepharospasm. The treatment of blepharospasm is often complicated and lengthy. It demands patience and optimism from the patient. Subsequent follow-up appointments are also important.
Treatment and therapy
If secondary blepharospasm is present, treatment of the underlying triggering disease is the primary concern. Because the causes of the primary form are unknown, its treatment is more difficult. Drugs such as benzodiazepines or muscle relaxants usually bring little improvement. In addition, there is a risk of severe side effects. For this reason, injections with the neurotoxin botulinum toxin A are usually administered. The patient receives the injection under the skin directly into the eye ring muscle. The botulinum toxin results in its paralysis. The dose is initially low to avoid disturbing side effects. The injection is usually made in four places around the eye. In the further course, the physician adapts the injection areas and dosage individually to the patient. Since the effect wears off after a certain time, the treatment must be repeated about every three months. The main side effects are turning of the eyelid outwards (ectropion) or drooping of the eyelid (ptosis).In some patients, surgery may also be necessary, which involves cutting nerve fibers of the facial nerve. Similarly, the eye muscle can be partially removed.
Outlook and prognosis
Blepharospasm requires immediate medical attention. In most patients, the condition increases the frequency with which they blink, requiring them to blink every two seconds on average. This can also trigger a spasm in the eyelid, which is described as painful. The blepharospasm reduces the quality of life of the affected person relatively strongly and can also lead to psychological problems or limitations. However, the symptom itself can be treated well. The spasm and paralysis are relieved by the doctor with the help of an injection, so that the pain also subsides in the process. In most cases, this requires four injections. Depending on the severity of the blepharospasm, the injections must be repeated after a certain period of time. A quarterly rhythm is suitable here. The eyelid is changed by the blepharospasm. For example, it may droop or move upward after treatment. As a rule, this cannot be predicted. This symptom can also be treated by surgery. The muscle itself can also be completely removed if necessary. The person affected by blepharospasm should watch out for stressful situations and avoid them. Likewise, prolonged television viewing or working at a computer promotes the symptom and should be avoided if possible. Treatment usually leads to a positive course of the disease.
Prevention
Specific preventive measures against blepharospasm are not known. Patients are advised not to watch television for too long and to avoid strong sunlight. Wearing darkened sunglasses to protect against bright light is also considered helpful.
What you can do yourself
Blepharospasm is not a disease that can be cured. On the contrary, the symptoms of the disease can increase greatly over a long period of time. Therefore, a visit to the doctor should not be waived. The disease can be detected very well in the early stages, so that treatment can be prescribed quickly. In the meantime, stressful situations and other stressful everyday events should be avoided. Stress reduction is often accompanied by symptomatic relief. Typical relaxation exercises or a calming tea can already have a very relieving effect. There are a variety of relaxation techniques that can be used to decelerate: Slow gymnastic exercises from yoga or breathing exercises from Buddhist meditation practice can help channel pent-up excitement out of the body. If Far Eastern spiritual exercises are not to one’s taste, relaxation exercises from the traditional medical field, such as autogenic training, can also be used. However, it should also be noted that complete healing cannot be guaranteed by relaxation sessions. It should therefore be checked by the ophthalmologist whether surgical intervention and/or drug treatment are necessary.
