Blefarospasme

Blefarospasme, or blepharospasm, is a focal dystonia defined by involuntary, repetitive contractions of the eyelid muscles, most notably the orbicularis oculi. These spasms lead to increased blinking and can cause involuntary eyelid closure, which may affect vision and daily activities. The condition typically begins in adulthood and can become bilateral over time.

The underlying mechanism is related to dysfunction in brain circuits that control motor activity, especially the basal ganglia-thalamocortical pathways. Blepharospasm can be idiopathic or occur as part of Meige syndrome, a combined blepharospasm with oromandibular dystonia. Sensory factors such as photophobia, eye irritation, fatigue, and stress can influence symptom severity and trigger episodes in some individuals.

Symptoms include frequent forceful blinking, sustained eyelid closure, facial grimacing, and difficulty keeping the eyes open for activities like reading or driving. Symptoms may be worsened by bright light, wind, or dry eyes, and can fluctuate in severity.

Diagnosis is primarily clinical, based on history and examination. Other conditions that resemble blepharospasm—such as eyelid myokymia, tics, or seizures—are considered in the differential diagnosis. Neuroimaging or other tests are not routinely required unless there are atypical features or concerns about other neurologic disorders.

Treatment is mainly symptomatic. The first-line therapy is botulinum toxin injections into the eyelid and periorbital muscles, which typically reduce spasms for several months. Repeated injections are common. Oral medications have limited and variable effectiveness. In refractory cases, options include advanced therapies such as deep brain stimulation or surgical approaches to the eyelid muscles. Protective measures and addressing triggers (eye protection, artificial tears) can aid comfort and function.