Blepharospasm is a neurologic disorder affecting the muscles controlling your eyelids. It starts off as twitching and can progress to not being able to open your eyes. Injections help many people get relief. Advanced cases may require lifestyle changes due to limited vision.
Blepharospasm is a neurologic disorder that causes uncontrollable muscle movements that causes the eyelids to close or have difficulty opening (dystonia). This can affect patients’ ability to see.
It's a rare disease and can be difficult to diagnose. Approximately 2,000 people are diagnosed with it each year.
Symptoms start with uncontrollable eyelid twitching (spasms) that comes and goes. It usually starts gradually and gets worse over time. As the disease progresses, you may experience constant blinking, and the opening between your eyelids may narrow. In advanced cases of blepharospasm, you may not be able to keep your eyes open or may be difficult to open your eyes.
Blepharospasm does not affect your vision, but it can lead to functional blindness. When you cannot keep your eyes open, it limits your ability to perform daily tasks.
What causes blepharospasm?
Researchers are still working to confirm its cause. Blepharospasm may be due to abnormal electrical activity in the basal ganglia, structures deep within the brain that help control movement.
Who gets blepharospasm?
Usually people get blepharospasm in middle age, but it can happen to anyone. Sometimes dry eye may look like blepharospasm so it is important to see your healthcare provider to rule out other causes for your excessive blinking. You could also experience blepharospasm if you take certain medications. For example, medications for Parkinson's disease can cause blepharospasm.
People with certain medical conditions can get blepharospasm. These conditions include:
What are the symptoms of blepharospasm?
In the early stages, you may have frequent blinking and the symptoms come and go. You’ll experience them during the day, and they’ll go away while you are sleeping. As the disease progresses, they become more severe with fewer periods of relief.
You may experience:
Healthcare providers diagnose blepharospasm after asking about your medical history and performing a physical exam. Because it is a rare condition, it’s important to seek care from a specialist familiar with it.
No laboratory tests are necessary.
There are three types of treatment for blepharospasm:
It depends on the severity of your symptoms and response to therapy. The most common and most effective treatment is botulinum toxin. Medications are effective in a small number of people. But they often cause side effects such as memory problems, drowsiness and dry mouth. When blepharospasm is not improved with medical therapy, surgery may be indicated.
Botulinum toxin injections are placed in muscles around the eyes to relieve constant blinking and eye narrowing in many people. Various patterns and doses of botulinum toxin can be used. Botulinum toxin usually lasts three to four months.
A small number of people experience temporary side effects that include:
Usually surgery for blepharospasm is reserved for patients that do not do well with botulinum toxin and/or medications, but you and your healthcare provider will decide what’s best for you.
Unfortunately, there is not much to do to prevent blepharospasm, but there are options to help. Seeking care from an experienced healthcare provider can help you start treatments sooner.
Some patients find it helpful to use special lens filters in their sunglasses or eyeglasses, such as rose tinted FL-41 lenses. In addition, optimizing dry eye treatment is helpful to decrease and eye irritation from dry eye.
As blepharospasm advances, you may not be able to control blinking or keep your eyelids open. This can affect your ability to perform daily tasks. You may need to adjust your lifestyle by:
Learning stress management techniques, like deep breathing and mindfulness, may quiet symptom triggers. In addition, some patients find trigger points on their face to help decrease the frequency and intensity of spasms.
Steps you can take include:
There is a national organization called the Benign Essential Blepharospasm Foundation (BEBRF--www.blepharospasm.org) where you can find helpful information and community support. In addition, your healthcare provider can direct you to community resources for people with limited vision. Referrals may include support groups and special activities for people with vision issues. Your loved ones can also be a valuable source of support and encouragement.
A note from Cleveland Clinic
Blepharospasm is a rare neurological disorder affecting the muscles that control your eyelids. It starts with constant blinking that progresses to not being able to keep your eyes open. Botulinum toxin injections can be used for symptom relief and requires injections usually every three months. Over time, the condition can bring changes to your abilities — including reading and working. But with community resources and support, you can still live a full, active life.
Last reviewed by a Cleveland Clinic medical professional on 05/21/2021.
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