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Blepharospasm
What is blepharospasm?
Blepharospasm is a disorder consisting of involuntary tonic contraction of the orbicularis oculi muscle and the eyebrow muscle complex. This produces a complete and intense eyelid closure of varying duration.
It can have an ocular cause and, for example, be secondary to an injury, while being solved when the problem that causes it is cured. However, there is also a type of blepharospasm called “essential”, when we do not find a physical cause for it.
This pathology should not be confused with a twitch, another form of involuntary movement of the eyelids that is also due to a contraction of the orbicularis oculi muscle. However, while a twitch is a mild and temporary disorder, blepharospasm is chronic and can significantly impact quality of life.
Generally speaking, essential blepharospasm begins insidiously with an increase in blinking, while increasing its duration and intensity and eventually leading to photophobia, dry eye and inability to keep the eyes open.
It tends to get worse in the afternoon, due to stress and while you are listening or walking. On the contrary, it decreases when you talk, which makes it difficult to diagnose.
Sometimes it is accompanied by spasm in one area of the face (hemifacial spasm).
Blepharospasm is a disease of the central nervous system that mainly affects women over the age of 50. It is usually of unknown origin, although some ocular conditions and emotional factors can act as triggers.
It is always necessary to carry out a neurological study to rule out an organic cause for it, for example, tumours, aneurysms or other injuries.
Blepharospasm is a difficult disease to treat, as we often do not know the cause.
It is important to treat the alterations that this pathology causes on the eye surface, since, due to the continuous and intense rubbing of the eyelids, it is usually greatly affected. The treatment includes lubricating and anti-inflammatory drugs, among others, but we advise that an eye surface expert prescribes them, due to its chronic symptoms. At the Miranza clinics, our specialist ophthalmologists work as a team to offer you a comprehensive approach.
It should be noted that blepharospasm also often requires antidepressant and/or anxiety treatment, as it is often associated with an emotional background.
On the other hand, botulinum toxin began to be used in humans precisely to treat blepharospasm (hence its usefulness to remove wrinkles was discovered). In this case, it does not have an aesthetic purpose, but a therapeutic one, as it allows us to relax the orbital muscles and thus avoid their involuntary contraction. Thanks to this, most patients can lead an almost normal life. However, the effect is not permanent and the botulinum toxin must be reapplied after a few months.
Faced with severe blepharospasms that do not respond to botulinum toxin injections, the surgical alternative is myectomy of the orbicularis muscle, which consists of totally or partially eliminating the muscle fibres involved in the eyelid movement. Thus, the hyperactive nerve fibres do not find any muscles to affect, whereas the spasms disappear or are reduced.
