Medicines for Blepharospasm

What it is

Blepharospasm is a condition causing involuntary, often forceful, contractions of the muscles that close the eyelids, leading to excessive blinking or the eyes squeezing shut, usually affecting both eyes. It is a type of "dystonia" — a group of conditions in which faulty nerve signals cause muscles to contract involuntarily. It often begins with increased blinking, sensitivity to light, or eye irritation, and can progress so that the eyelids close frequently or for longer, which, in more severe cases, can interfere with vision and daily activities (such as reading or driving) even though the eyes and vision themselves are normal. The spasms may be worsened by bright light, stress, tiredness, or particular activities, and typically stop during sleep. The exact cause is often not known (it is usually a form of primary dystonia), though it sometimes relates to other conditions or medicines. It is different from the common, harmless, brief eyelid twitch. While blepharospasm is not dangerous and does not damage the eyes, it can be functionally disabling and distressing, so effective treatment is important.

How it is treated

Blepharospasm is assessed by a doctor (often an eye specialist or neurologist), who confirms the diagnosis and looks for any contributing factors. The most common and effective treatment is injections of botulinum toxin into the muscles around the eyes, which relax the overactive muscles and reduce the involuntary closing; the effect lasts for a period (typically a few months) and the injections are repeated, and this helps the great majority of people significantly, often being the mainstay of long-term management. Simple measures can help symptoms — such as wearing tinted glasses for light sensitivity, and managing dry eye or irritation — and some people find certain "sensory tricks" temporarily ease the spasms. Some medicines are tried in certain cases, though they are often less effective than injections. For severe cases not helped by injections, surgical options exist but are used less commonly. Reassurance that the condition, while disabling, is not dangerous and does not harm the eyes is important, and support (including patient groups) can help. The reassuring message is that blepharospasm is usually well controlled with botulinum toxin injections, which effectively reduce the spasms and improve function.