What is Blepharospasm? Causes, Symptoms and Treatment

What Is Blepharospasm?

Blepharospasm or benign essential blepharospasm (BEB) is the involuntary blinking or twitching of one or more eye muscles. In fact, the word Blepharospasm itself is from the Greek words blepharon, meaning eyelid, and spasmos meaning spasm or uncontrolled contraction.

Whilst eye twitching can be a nuisance, and feel quite strong, they are not normally seen by others or when looking into a mirror, they are short-lived and end on their own, however, blepharospasms can be more severe and become chronic (long-lasting).

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 known that symptoms can be triggered by everyday activities such as

• Stress
• Eye strain
• Being fatigued
• Excessive screen time
• Dry eyes
• Eye Trauma
• Blepharitis

It can also be triggered by neurological conditions such as

• Tourettes syndrome
• Parkinson's disease
• Multiple sclerosis
• Cerebral  palsy
• Medications - such as HRT, Benzodiazepines 

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 who 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. The 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.

Different Types Of Blepharospasm

There are actually two types of blepharospasm, essential and reflexive, but both exhibit nearly the exact same symptoms. 

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 has 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, tranquillising medication, 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. Treating this condition with medication can be a challenging course of trial and error before settling on effective treatment, but it may not be effective for everyone.

• Botulinum Toxin Injections – Popularly known as Botox, this derivative of botulism is effective at inducing localized partial paralysis, which can stop the muscles around the eyes from twitching. The effects of the injections are almost immediate. 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 people 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 who 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.