Blepharospasm is a medical pathology that manifests itself through involuntary muscle contractions of the eyelid muscles. The disease can be diagnosed in the early stage characterized by rare episodes. This condition is self-limiting, its manifestations improving after a certain interval. In advanced stages, it is called essentially benign blepharospasm. It consists in the chronicity and worsening of the symptoms.
Causes of blepharospasm
Blepharospasm (eye twitching) has an increased incidence in people aged between 40-60 years. The cause of this pathology is the presence of abnormal activities at the level of the cerebral basal ganglia that control the contraction of the eyelid muscles.
Risk factors of blepharospasm
Anyone can develop blepharospasm. However, this pathology manifests itself with a high frequency in people who present the following risk factors:
- Medication: Some medications can cause blepharospasm. Among them are those administered in the treatment of Parkinson’s disease.
- General dystonia: Dystonias are defined as involuntary muscle contractions. These can be primary, as a result of a degenerative or metabolic disease, present at the level of the central nervous system. They can also be generated by the consumption of drugs that cause spastic muscle contractions.
- Meige syndrome: Meige syndrome is characterized by involuntary movements of the muscles of the temporomandibular joint (the joint that allows the mobility of the mandible) and spastic contractions of the eyelid muscles (blepharospasm). This pathology is hereditary or can be acquired as a result of infections or trauma.
- Tardive dyskinesia: tardive dyskinesia is a pathology that occurs more frequently in the elderly. The cause of this disease is the long-term use of antipsychotic medication. Among the manifestations of tardive dyskinesia are dystonia, tremors, agitation, and blepharospasm.
- Wilson’s disease: Wilson’s disease is a pathology with hereditary transmission. The cause of this disease is the massive retention of copper in the body. The specific symptoms of Wilson’s pathology are represented by involuntary muscle contractions, speech disorders, blepharospasm, and jaundice.
Types of blepharospasm
Depending on the complexity of the symptoms, the pathology was classified into:
- tics and spasms: Initially, the pathology begins with the presence of tics and spastic seizures of the eyelid muscles. The most frequent cause of their appearance is stress or fatigue. The amplitude of the spasms is reduced, and the duration of the crises is reduced
- chronic blepharospasm: This stage of the disease is characterized by the increase in the intensity of the spasms and their chronicity
Symptoms of blepharospasm
Blepharospasm can initially be manifested by:
- involuntary blinking
- spasms of the eyelid
- xerophthalmia (drying sensation of the eyeballs)
- twitching
- irritated eyes
- involuntary closing of the eyeballs
Blepharospasm attacks can occur both during the day and at night.
As the disease progresses, the severity of the symptoms increases. Among the characteristics of chronic blepharospasm are:
- trigger stimuli: Unlike the initial blepharospasm, where the crises were triggered randomly, the chronic pathology also manifests itself in the presence of certain stimuli.
- increased frequency of seizures
- strong spastic contractions with a longer duration
- Chronic blepharospasm is characterized by increasing intensity of symptoms. Thus, the contractions become stronger. Also, their duration increases, thus the patient will be forced to remain with his eyes closed for a longer period.
- change in physiognomy as a result of blepharospasm. The contractions of blepharospasm can lead to changes in physiognomy. Thus, along with the aggravation of the symptoms, the phenomenon of pulling the upper part of the eyelid (eyebrows) towards the eye also appears.
Diagnosis of blepharospasm
If a person presents symptoms suggestive of blepharospasm, a visit to the specialist is indicated. The doctor will perform an anamnesis, which will include questions about:
- The onset of symptoms: The onset of symptoms is a very important element in the anamnesis process. Early diagnosis of the symptoms of blepharospasm leads to the establishment of an adequate treatment and the avoidance of complications. Thus, the patient’s healing is faster.
- Triggering stimuli of blepharospasm crises: In the early stage, the disease manifests itself rarely, without depending on the existence of a stimulus. Along with the lack of administration of adequate treatment and the neglect of the disease, seizures can be associated with some triggering stimuli.
- Duration of pathological episodes: The duration of the episodes can characterize the type of blepharospasm. Thus, the early disease is characterized by a short duration of spastic crises. In its evolution, without adequate treatment, patients present contractions with an increased duration. These can lead to inconveniences in social and professional life.
- Frequency of blepharospasm attacks: The frequency of blepharospasm episodes can provide important information in the diagnostic process. Thus, in the early stage of the disease, seizures occur with a low frequency both during the day and during the night. The chronicity of the disease leads to the appearance of stimuli that increase the frequency of blepharospasm.
- The patient’s medical history: In the medical history, the patient may have other pathologies that cause blepharospasm. Among the pathologies that can lead to the secondary appearance of eyelid muscle spasm are: Wilson’s disease, Meige’s syndrome.
- Hereditary antecedents (family history of the disease)
- Neurocognitive disorders: Some neurocognitive disorders can trigger blepharospasm attacks. Thus, stress and depression are important factors that determine the manifestation of this pathology.
- The medication: The medication used in some pathologies can have as a side effect the occurrence of spasm attacks of the eyelids. Thus, the treatment of Parkinson’s disease causes the manifestation of blepharospasm.
- Alcohol consumption
- Smoking
After taking the anamnesis, the specialist doctor performs the objective examination of the patient. It can highlight:
- spastic seizures of the eyelid muscles
- forced closing of the eyes
- traction in the lower part of the eyebrows
- xerophthalmia
Treatment
The treatment of blepharospasm is indicated by the specialist depending on:
- severity of symptoms
- complications
- the onset of the disease
- response to treatment
Thus, the doctor can recommend a treatment:
- Drugs: The drugs used in the case of blepharospasm are of the anticholinergic type. These have the role of inhibiting the involuntary contractions of the eyelid muscles. The drug treatment is administered orally.
- Using botulinum toxin injections: Botulinum toxin is used to reduce the ability of the eyelid muscles to contract. Thus, by injecting it, the frequency and severity of blepharospasm manifestations are reduced. The duration of the effect of botulinum toxin injection is approximately 4 months. The efficiency of this type of treatment is high in this pathology. Side effects are temporary and may include: blurred vision, diplopia (double vision), xerophthalmia, and palpebral ptosis (falling of the eyelid).
- Surgical (myectomy): Surgical treatment is used only in selected cases, in which the initial therapies did not improve the symptoms. Myectomy involves the surgical removal of the eyelid muscles that exhibit spastic contractions.
Conclusion
Blepharospasm is a pathology manifested by involuntary contractions of the eyelid muscles. In the early stages, seizures occur rarely, and the symptoms are mild. As the disease progresses, the symptoms become severe, and seizures occur more and more frequently. Also, the pathology can also associate certain triggering factors. The diagnosis of blepharospasm is made by the specialist doctor, depending on the information from the anamnesis and the objective examination. The treatment of this pathology can be medicinal, surgical or with the help of botulinum toxin injections.
Bibliography:
- https://www.aanem.org/Patients/Muscle-and-Nerve-Disorders/Blepharospasm
- https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/blepharospasm ,
- https://my.clevelandclinic.org/health/diseases/21546-blepharospasm#symptoms-and-causes
