Blepharo means “eyelid”. Spasm means “uncontrolled muscle contraction”. The term blepharospasm ['blef-a-ro-spaz-m] can be applied to any abnormal blinking or eyelid tic or twitch resulting from any cause, ranging from dry eyes to Tourette’s syndrome to tardive dyskinesia. The blepharospasm referred to here is officially called benign essential blepharospasm (BEB) to distinguish it from the less serious secondary blinking disorders. It is a chronic benign (non life threatening) condition with abnormal, uncontrolled (involuntary) eyelid and facial spasms or contractions on both sides. Patients with blepharospasm have normal eyes. The visual disturbance is due solely to the forced closure of the eyelids. Blepharospasm should not be confused with true eyelid droopiness (ptosis) and hemifacial spasms (one sided eyelid or facial spasms/contractions). Support groups are available (www.blepharospasm.org).
The mainstay treatment for blepharospasm (and hemifacial spasm) is periodic botulinum toxin injections. This is a toxin produced by the bacteria Clostridium botulinum. It weakens the muscles by blocking nerve impulses transmitted from the nerve endings of the muscles. When it is used to treat blepharospasm, minute doses of botulinum toxin are injected intramuscularly into several sites above and below the eyes. The sites of the injection will vary slightly from patient to patient and according to physician preference. They are usually given on the eyelid, the brow, and the muscles under the lower lid. The injections are carried out with a very fine needle.
There are a variety of botulinum toxin products including BOTOX, DYSPORT, and XEOMIN. Botox was first approved in 1989 to treat blepharospasm. They each work by temporarily weakening or paralyzing the affected spasmodic muscles. Benefits begin in 1-14 days after the treatment and last for an average of three to four months. Long-term follow-up studies have shown it to be a very safe and effective treatment, with up to 90 percent of patients obtaining almost complete relief of their blepharospasm. Side effects are usually rare and technique dependent. They include drooping of the eyelid (ptosis), double vision (diplopia), and tearing. All are transient and recover spontaneously.
There are surgical treatments available for refractory blepharospasm, including facial nerve ablation and orbicularis myectomy. Dr. M. Ray Taban, assistant clinical professor of oculoplastic surgery at UCLA who treats many patients with this chronic
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