blefparasmia

Blefparasmia is a term sometimes used to describe blepharospasm, a focal dystonia involving the muscles around the eyes. It is characterized by involuntary, often repetitive contractions of the orbicularis oculi muscle, which can produce increased blinking, eye tightness, and, in more advanced cases, intermittent or sustained eyelid closure. Patients may also experience photophobia, dry eye sensations, or difficulty keeping the eyes open, particularly in bright light or when fatigued.

Most cases are idiopathic but can be associated with broader dystonia syndromes. Blefparasmia can occur on its own or as part of Meige syndrome when accompanied by oromandibular dystonia. Risk factors are not well defined, and the condition typically presents in middle age or later, with a female predominance reported in some series. The diagnosis is clinical, based on the pattern of eyelid spasms and exclusion of other causes such as dry eye, conjunctivitis, cosmetic lid procedures, or neurological conditions that affect facial movement. In selected cases, evaluation by a neurologist, ophthalmologist, or movement disorder specialist may be helpful, including review for signs of associated dystonia.

First-line treatment is botulinum toxin injections around the eyes, which reduce muscle overactivity and blinks with effects lasting several months. Other options include oral medications (such as anticholinergics or muscle relaxants) for some patients, though there is variability in response and tolerability. In refractory cases, surgical approaches to reduce eyelid closure or address accompanying dystonia may be considered. The course is often chronic with fluctuating intensity; repeated treatments are commonly needed to maintain symptom control.