Why eye dystonia is often misdiagnosed


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Marion1This article is from the blog of Dr Marie-Helene Marion. She writes articles on a wide range of topics relating to dystonia that you can read by clicking here. In this article, she talks about the problems diagnosing eye dystonia (blepharospasm).

The diagnosis of Blepharospasm is always delayed!

Blepharospasm is a focal adult- onset dystonia, responsible of an involuntary eye closure. It can start with an increased blinking explained by dry eyes, gritty eyes or intolerance to bright lights. Gradually the patient, more often a woman around her 60’s, complains of difficulty watching TV, driving at night or just walking outdoors on a cloudy day
 
At that stage, surprisingly the diagnosis is not easily done. Why?

1-    The GP refers this lady to the eye clinic; the diagnosis of blockage of the lacrymal ducts, or of blepharitis (with an inflamation of the eyelids) are much more common conditions and often the first to be considered.
 
2-    The patient does not spontaneously mention that the eyes are involuntary closing. They more often talk about their heavy eyelids, or tired eyes, or intolerance to bright light (also called photophobia)
 
3-    The patient has often the eyes well opened when speaking and the doctor can’t document any forceful eye spasms during the clinic.
 
This explains that the diagnosis of dystonia (Blepharospasm, Neck dystonia) is usually made 5.4 years on average after onset of symptoms and at least after seeing 3 different consultants (Canadian survey of Dr Jog ).

The patient will benefit from coming to the first clinic with a relative or a friend who may describe it more accurately as an external observer. I also ask my patients to stop talking and be silent for few minutes, fixing a visual target in the room; the spasms with forceful eye closure will occur 2 to 3 minutes later. It’s worthwhile waiting as it’s a great opportunity not only to make the diagnosis but also to identify the type of Blepharospasm.
 
 Hope this blog will contribute to an earlier diagnosis of Blepharospasm!
 
 Reference: Causes of treatment delays in dystonia and hemifacial spasm: a canadian survey. Jog M et al, Can J Neurol Sci 2011: 38:704-11

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