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Essential blepharospasm: causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
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Essential blepharospasm is an idiopathic progressive disease, accompanied by involuntary tonic spastic contractions of the orbicularis oculi muscles of both eyes lasting from several seconds to several minutes and over the years leading to complete closure of the eyelids.
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What causes essential blepharospasm?
The cause of essential blepharospasm is unknown, but the central genesis of the lesion is assumed. The disease usually occurs in people over 50 years of age, and is often associated with Parkinson's disease. Women get sick 3 times more often.
Symptoms of Essential Blepharospasm
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 can also 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).
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Treatment of essential blepharospasm
Treatment of essential blepharospasm can be conservative and surgical. Medications for the treatment of essential blepharospasm are generally ineffective. The method of choice is local injections of botulinum toxin (type A), which causes temporary paralysis of the orbicularis oculi muscle. Surgical treatment (myectomy) is performed in cases of intolerance to botulinum toxin or ineffectiveness of treatment with this drug.
Essential blepharospasm is generally difficult to treat; relapse of the disease after botulinum toxin injection occurs after 3-4 months, which requires repeated courses of injections.