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Although essential benign blepharospasm (EBB) was first described in an American medical journal in 1985, it has been in recent years that doctors have begun to recognize it as a physical rather than a psychological disorder. Although there is currently no definitive cure for blepharospasm, there are treatments that effectively reduce symptoms and allow most patients to lead a normal life.
Blepharospasm is the involuntary closure of the eyelids. El cierre es intenso, crónico y bilateral. Involuntary muscle contractions are due to malfunctioning neurons of the central nervous system and involve the fifth and seventh cranial nerves.
The first symptoms of blepharospasm may be an occasional increase in blinking in one or both eyes, or simply difficulty in keeping the eyes open. Most patients with blepharospasm are also sensitive to light (photophobia) and dry eyes. If the disease progresses, spasms of the eyelids begin to increase in frequency until they become constant. This disease is usually progressive in that periods of spasm may increase in frequency and periods of relaxation may become shorter. However, in some cases, the spasms reach a plateau and remain at this level without progressing.
Symptoms usually begin in the fifth and sixth decade of lifeand are three times more common in women. There is no proof that blepharospasm is hereditary. However, there are some families in which more than one member has blepharospasm and/or Meige’s syndrome or other forms of dystonia, suggesting that in some families there would be a certain genetic predisposition.
This is a clinical diagnosis. There is no specific test to make the diagnosis. It is common for patients to initially think that their problem is simply a bad habit, or due to nerves or stress, and not seek medical attention.
Spasms may increase in frequency and duration so that the patient becomes functionally blind. Facial spasms, if intense, can interfere with talking or eating. Patients may have great difficulty driving, reading, watching television, or performing any other activity necessary in daily life.
Eyelid apraxia associated with blepharospasm is the most common cause of failure or poor benefit from botulinum toxin. Patients who present have difficulty opening their eyelids even after palpebral spasms have been reduced with botulinum toxin. So even without spasms they have difficulty opening their eyes. These patients need an interval of time after the spasm to be able to open their eyelids.
The goal of treatment is to help patients maintain a satisfying lifestyle and to help both the patient and family live with the disease and its possible limitations. Treatment with botulinum toxin injections is currently the treatment of choice for blepharospasm. Treatment with botulinum toxin injections is currently the treatment of choice for blepharospasm. Mainly the orbicularis muscle and the corrugator muscles. These injections temporarily weaken the muscles, decreasing the frequency and intensity of the spasms.
The effect of the injections is always temporary and typically lasts about 3 months. It is therefore necessary to repeat the treatment to maintain the effect. Surgical approach – Myectomy: This procedure is reserved for patients resistant to botulinum toxin treatment. It consists of the partial or total removal of the muscles responsible for closing the eyes, mainly the orbicular muscle. After surgery, it may sometimes be necessary to continue botulinum toxin infiltrations. Botulinum toxin is not effective in treating apraxia of the palpebral opening. In a small percentage of patients in whom the apraxia is very disabling, it may be necessary to perform surgical interventions such as frontal suspension to help open the eyelids.
Dr. Nieto is a reference in oculoplastic surgery. He combines his activity in reconstructive surgery in public medicine with his private reconstructive and cosmetic activity at the Clínica Corachán in Barcelonaand the Instituto Oftalmólogico Gabriel Simón in Madrid.
Clínica Corachán 2, bajos. Plaza Manuel Corachán 4, Despacho 8 Barcelona 08017
Instituto Oftalmológico Gabriel Simón Fuencarral, 7 28004-Madrid
