This page contains information about blepharospasm (eye dystonia) for medical professionals. For information on blepharospasm for patients and carers please click here.
Blepharospasm is uncontrollable and often painful muscle contractions around the eyes. Blepharospasm is a neurological movement disorder and should be diagnosed and treated by an ophthalmologist or a neurologist specialising in movement disorders. It is caused by muscle spasm in the orbicularis oculi and its adjacent muscles. It affects around 7,000 adults in the UK
Blepharospasm is classified as a focal dystonia which means it affects only one region of the body. In the majoirty of cases the dystonia does not spread to other areas. However, in a minority of cases, other regions of the body also become affected and the dystonia is classified as a multifocal or segmental dystonia. When blepharospam occurs together with oromandibular (mouth, jaw or tongue) dystonia, this is called Meige’s syndrome.
Blepharospasm is usually an idiopathic dystonia. This means that torsion dystonia is the only clinical sign (apart from tremor) and there is no identifiable exogenous cause or other inherited or degenerative disease.
Blepharospasm usually appears between the ages of 50 and 70 so it is classified as late onset. However, it does sometimes affect younger people.
Blepharospasm usually starts gradually. Initial symptoms may include eye irritation, excessive watering of the eyes, a gritty or uncomfortable feeling in the eyes, sensitivity to light and increased blinking. Once blepharospasm has developed, symptoms may include excessive blinking and involuntary closure of the eyelids. It is usually present in both eyes. The frequency and severity of the muscle spasms in blepharospasm generally increases over a period of one to two years.
Blepharospasm does not affect the ability of the eye itself to see but can cause impaired vision due to the forced closure of the eyelids sometimes for prolonged periods.
Blepharospasm is often misdiagnosed by GPs. Conditions that blepharospasm is commonly mistaken for include:
- Dry eye,
- Eye strain / tired eyes / tic (e.g. from overuse of computer or reading)
- Myasthenia Gravis
- Psychological problem
Indicators for a GP that the diagnosis may be blepharospasm rather one of these other conditions include:
- Does not respond to dry eye treatment
- Does not clear up over time
- Dark glasses may ease symptoms
- Symptoms sometimes respond to sensory tricks such as touching the corner of the eye or side of face
Treatment for blepharospasm usually involves regular injections , using a tiny needle, administered either by a neurologist or ophthalmologist and/or oral medication can also be prescribed. Some people find relief by applying light pressure to particular points on their face; symptoms of blepharospasm can also be reduced by wearing dark glasses or wearing a hat with a peak. It is very much an individual experience.
Unfortunately there is currently no cure for blepharospasm. However, in the vast majority of cases, dystonia does not impact intelligence or shorten a person's life span. Most people do manage to develop successful strategies for living with dystonia combining treatment with pain control and sensory tricks.
Dystonia is not a mental health condition but it can cause depression and anxiety due to the pain, stigma and social isolation of the condition. The overall rate of psychiatric symptoms amongst individuals with dystonia is often higher than that seen in the general population, with onset of the psychiatric symptoms prior to the physical symptoms of dystonia in some cases.
Psychological therapies such as cognitive behavioural therapy (CBT) and counselling can therefore play an important role. In addition, as stress and anxiety can exacerbate the physical symptoms of dystonia, effective management of these can also improve the outcome of managing the physical symptoms.
Mindfulness (autogenic training or meditation) can also be helpful. In a Dystonia Society questionnaire, mindfulness was reported helpful by 65% of those who tried it.
Last reviewed July 2014
The Dystonia Society provides the information on this page as general information only. It is not intended to provide instruction and you should not rely on this information to determine diagnosis, prognosis or a course of treatment. It should not be used in place of a professional consultation with a doctor.
The Dystonia Society is not responsible for the consequences of your decisions resulting from the use of this information, including, but not limited to, your choosing to seek or not to seek professional medical care, or from choosing or not choosing specific treatment based on the information. You should not disregard the advice of your physician or other qualified health care provider because of any information you receive from us. If you have any health care questions, please consult the relevant medical practitioner.