Blepharospasm: causes, symptoms, diagnosis, treatment

Blepharospasm is a spasm of the muscles around the eye that causes involuntary blinking and closing of the eye.

What causes blepharospasm?

Blepharospasm occurs reflexively in diseases of the cornea. It is especially pronounced in children with tuberculous-allergic keratoconjunctivitis. The eyelids are convulsively compressed, the patient is unable to open them due to photophobia. With prolonged spasm, congestive edema of the eyelids appears.

Blepharospasm can occur as a result of other eye diseases, but most often the cause is unknown. It occurs more often in women than in men and has a family history. Secondary blepharospasm can also occur in people with eye irritation (eg, trichiasis, corneal foreign body, keratoconjunctivitis sicca) and systemic neurological diseases (eg, Parkinson's disease).

How does blepharospasm manifest itself?

Symptoms include involuntary blinking and closing of the eyes; in severe cases, patients are unable to open their eyes. Spasms may be aggravated by fatigue, bright light, and anxiety.

Blepharospasm is a progressive disease, accompanied by involuntary tonic spastic contractions of the orbicularis oculi muscles of both eyes lasting from several seconds to several minutes - clonic (rapid and intense blinking); tonic contraction (spasm), leading to narrowing of the palpebral fissure and over the years even to complete closure. The disease usually occurs in people over 50 years old, often associated with Parkinson's disease. Women get sick three times more often. There may be one- and two-sided spasm, combined with spasm of the muscles of the face, arms, legs. The cause of the disease is assumed to be the central genesis of damage to the nervous system. A painful tic may occur with neuralgia (irritation) of the trigeminal nerve with dental caries, nasal polyps, after a neuroinfection and mental trauma, it can be caused by diseases of the anterior segment of the eye, with electrophthalmia, etc. It is often observed with lesions of the conjunctiva and cornea, often in children aged 7-8 years after an infection, mental trauma, when a foreign body gets behind the eyelids and with a number of eye diseases, when eyelid spasm develops reflexively.

Spasms are almost always bilateral, usually begin with light twitching, and over time can develop into contractures and spasms of the muscles of the upper part of the face. In severe cases, the disease can progress until the patient becomes practically blind. Provoking factors are stress, bright light, and visual strain.

Differential diagnostics are performed with hemifacial spasm; MRI or MRI angiography is required to clarify the diagnosis. Trigeminal neuralgia, extrapyramidal diseases (encephalitis, multiple sclerosis), psychogenic conditions may be accompanied by blepharospasm. Differentiate from reflex blepharospasm, which occurs when stimulating the branches of the trigeminal nerve (corneal ulcer, foreign body in the cornea, iridocyclitis).

Treatment of blepharospasm

Treatment of blepharospasm can be conservative and surgical. Treatment depends on the cause of the disease. In some cases, periorbital novocaine blockades, massage, bromine preparations, analgesics, 1% dicaine solution help. Treatment of the underlying disease is mandatory. But in general, drug treatments for blepharospasm are ineffective. Recently, local injections of botulinum toxin (type A) have been used, which causes temporary paralysis of the orbicularis oculi muscle,

Surgical treatment of blepharospasm (lyectomy) is performed in cases of intolerance to botulinum toxin or ineffectiveness of treatment with this drug.

Blepharospasm is difficult to treat; relapse of the disease after botulinum toxin injection occurs after 3-4 months, which requires repeated courses of injections.

Sunglasses reduce sensitivity to light that may cause or accompany blepharospasm.