Dorothy FarrarBlepharospasmus
Blepharospasm – also known as eyelid spasm – is a heavy burden for those affected, despite its harmless-sounding name, since their facial expressions have changed significantly. It either occurs without an identifiable cause or is a symptom of an underlying medical condition. The disease occurs in only 3 to 4 out of 100,000 people and mostly affects middle-aged or older women.
What is blepharospasm?
Blepharospasm is what doctors mean by an involuntary, violent spasm of one or both eyelids. The condition occurs spontaneously and transiently or is permanent without the sufferer having any control over it. The muscles involved in uncontrollable eyelid spasm are the orbicularis oculi muscle and sometimes other muscles near the eyelids.
The disease occurs in three forms: as classic blepharospasm with short-term recurring spasms, as permanent spasm of the eyelid (tonic blepharospasm) and as inhibition of lid opening. With her, the patients are no longer able to open their eyes (further), although no muscle spasms are visible from the outside. It is not caused by a contracting eye ring muscle, but by a spasm of the forehead muscle. Such a lid opening apraxia (functional blindness) is also present when the patient repeatedly closes the eyelids without being able to influence this process voluntarily.
The tonic eyelid spasm leads to a permanent narrowing of the eyelid gap. However, the doctor speaks of paradoxical dystonia when the spasms improve when the patient walks around or talks. The eyelid spasm can affect the quality of life of those affected so much that they get serious mental problems. Severe blepharospasm can sometimes result in blindness.
Causes
The exact medical causes of blepharospasm are still unknown. Depending on the cause of the rare disease, doctors distinguish between two forms. The primary (essential) eyelid spasm occurs without an identifiable cause. However, it appears to be due to a disturbance in the biochemical balance within the brain ‘s basal ganglia . How it comes about is still unclear. Symptomatic (secondary) blepharospasm is caused by damage to the central nervous system (brain and spinal cord ). Other causes of the psychologically stressful cramping of the eyelids are eye or nerve diseases. Primary blepharospasm is more common than eyelid spasm caused by an underlying condition.
Diseases
- Diseases of the central nervous system
- Diseases of the spinal cord
- conjunctivitis
When to the doctor?
Every person experiences a slight tremor of the eyelid in the course of his life. This is not normally a health hazard condition that requires medical attention. If the tremor goes away after periods of recovery, it is an emotionally distressing condition that is temporary. If the symptoms have disappeared after waking up from a restful sleep, no further measures or therapies are required.
If the symptoms clearly increase in intensity over several days or weeks, the current lifestyle should be checked. Most triggers include a lack of sleep, mental or emotional stress. If the affected person manages to master the prevailing situation on their own, the disease will be alleviated. As soon as the current condition is classified as stressful or impeding in coping with everyday life, a neurologist should be consulted and help sought. This also applies if the symptoms worsen or increase continuously over several weeks.
If the eyelid stays closed for several hours a day, vision is impaired. Since the narrowing of the lid gap leads to functional blindness, a doctor should be consulted. If you have other symptoms such as headaches , neck cramps, permanent facial tension, local pain or hypersensitivity to light, you should consult a doctor.
Diagnosis and course
If a person often experiences cramping of an eyelid, blinking, or complains of a foreign body sensation in the eye , they should consult an ophthalmologist as soon as possible. During the examination, the doctor determines how often the patient blinks. If he does this more than 27 times a minute – up to 20 times would be normal – there is an eyelid spasm. Then the eye muscle activity is measured by electromyography (EMG) on the eye ring muscle and other muscles located near the eye. Magnetic resonance imaging is used to find out whether the eyelid spasm is caused by a nerve disease .
The eye examination with the slit lamp is used to diagnostically exclude conjunctiva or corneal irritation and acute or chronic eye inflammation. The cramping of the eye muscles is initially only seen on one side in many of those affected and is only mild: it looks as if they are blinking. Sometimes the patients only have a foreign body sensation in the eye. As the disease progresses, her facial expressions change rapidly. Cramps become more frequent and last longer. The spasmodic jerks occur every 20 seconds and last for minutes.
In the beginning, this condition can be ended with tricks such as chewing gum or yawning. Patients with essential blepharospasm show more pronounced symptoms when they are exposed, for example, to bright light, draughts, or (emotional) stress . The symptoms usually do not occur as frequently and intensively inside closed rooms as outside. Some of them also show their symptoms while reading. The severe symptoms often subside at night, so that the patient has less severe symptoms the next morning.
Complications
Common complications of blepharospasm include pain and spasms in the region of the eyes. As the disease progresses, a progressive development of symptoms is to be expected. As a result, there is an increase in the level of suffering in the sufferer. Well-being decreases and mental stress increases in parallel. The pain occurs in the muscles around the eye. In addition to cramps, these can also lead to further injuries to individual muscle fibers due to the stress. This spreads the pain sensation. In severe cases, the ability to see is severely impaired.
In addition, blindness can occur. Blepharospasm can cause lid fissure narrowing. In most cases, these complications lead to an increase in mental resilience. Therapeutic measures should be taken to treat disorders such as melancholy or depressionto prevent Visual perception can increase sensitivity to light. Headaches and avoidance of light are the consequences. In some cases, there is a formation of hematomas. These cause more pain. The blepharospasm is often accompanied by the administration of medication. These usually have other side effects. They include problems with digestion, dry mouth or forgetfulness. In addition, increased and uncontrollable tear flow can occur.
Treatment and therapy
The blepharospasm is treated causally – i.e. according to the cause of the disease. If no cause is obvious, local administration of Botox (botulinum toxin A, BTX) can be helpful. A very small dose of the neurotoxin is injected with a very thin needle in four places around the eye directly into the cramping muscle. The puncture usually does not cause any pain . The bacterial toxin paralyzes the eye ring muscle within the next three days. In one to two weeks at the latest, the muscle is then completely relaxed.
However, since the botulinum toxin A is broken down by the body over time, the treatment must be repeated about every 3 months. In the case of a one-sided eyelid spasm, the doctor injects Botox 2 to 3 times a year. In individual cases, permanent drooping (ptosis) or outward turning of the eyelid (ectropion) can occur. In 5 to 10 percent of patients affected by blepharospasm, the muscle-paralyzing poison has no or only insufficient effect.
The treating physicians often refrain from administering muscle-relaxing drugs ( muscle relaxants ) or sedatives such as benzodiazepines, since these drugs only slightly improve the patient’s condition. In addition, they often have strong side effects. Another therapeutic option is the complete or partial surgical removal of the orbicular muscle or the severing of the nerve connections between the facial nerve (facial nerve) and the orbicular muscle. If the eyelid spasm has psychological causes or is it stress-related, psychotherapy , hypnosis or alternative medical procedures such as acupuncture can be useful.
Outlook and prognosis
Blepharospasm is bilateral in most people. The first signs are expressed by restless and increased blinking and an involuntary twitching of the eyelids . Later, an unpleasant cramping of the eyelids occurs, which the person concerned cannot control. The individual symptoms increase in intensity over the coming hours and throughout the day.
Bright light stimuli, stress, puffs of air and not getting enough sleep at night increase blepharospasm. It can lead to a permanent contraction and thus to a complete closure of the eyes. This lasts for several hours and dissolves after a period of regeneration. Sleeping at night improves the symptoms. The blepharospasm is less pronounced in the morning than in the evening hours. As long as the cause is not clarified and eliminated, an increase in complaints can be expected. The eye closure adjusts earlier and lasts longer.
Blepharospasm is easily treatable. A neurologist makes the diagnosis and initiates measures to treat the underlying disease. At the same time, he treats the patient’s eye ring muscle to prevent further cramping. Because this is a temporary therapeutic option, blepharospasm will not heal until the underlying cause is identified and cured.
Prevention
The patient cannot prevent the occurrence of blepharospasm. However, he should avoid strong sunlight and not watch TV for too long. Wearing very dark sunglasses can also help prevent eyelid spasms.z
In addition, the disturbing blepharospasm symptoms always disappear when the patient performs an activity that is unfamiliar to him, such as walking backwards or lying down.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.