What is Benign Essential Blepharospasm?
Although benign essential blepharospasm (BEB) was first described in an American medical journal in 1985, it’s only in recent years that doctors have begun to recognize it as a physical, rather than a psychological, disorder . Although blepharospasm currently has no definitive cure, there are treatments that effectively reduce symptoms and allow most patients to lead normal lives.
- Blepharo : Derived from Greek and means eyelid.
- Spasm : Strong, involuntary contraction of the muscles
- Essential : Of unknown cause
Blepharospasm is the involuntary closure of the eyelids . The closure is intense, chronic, and bilateral. The involuntary muscle contractions are due to malfunctioning neurons in the central nervous system and involve the fifth and seventh cranial nerves .
The first symptoms of blepharospasm may be occasional increased blinking in one or both eyes, or simply difficulty keeping the eyes open. Most patients with blepharospasm also experience light sensitivity (photophobia) and dry eyes. As the condition progresses, eyelid spasms begin to increase in frequency until they become constant. The condition is usually progressive, meaning that the periods of spasm may increase in frequency and the periods of relaxation may become shorter. However, in some cases, the spasms reach a plateau and remain at this level without progressing.
Preguntas frecuentes sobre blefaroespasmo
-
Symptoms usually begin in the fifth and sixth decades of life , and it is three times more common in women. There is no evidence that blepharospasm is hereditary. However, there are some families in which more than one member has blepharospasm and/or Meige syndrome or other forms of dystonia, suggesting that there may be a genetic predisposition in some families.
-
This is a clinical diagnosis . There is no specific test to make the diagnosis. It’s common for patients to initially think their problem is simply a bad habit, or due to nerves or stress, and not seek medical attention.
-
The spasms may increase in frequency and duration, causing the patient to become functionally blind . Facial spasms, if severe, may interfere with speaking or eating. Patients may have significant difficulty driving, reading, watching television, or performing any other activities necessary for daily living.
-
Apraxia of eyelid opening associated with blepharospasm is the most common cause of failure or limited benefit with botulinum toxin . Patients with this condition have difficulty opening their eyelids even after eyelid spasms have been reduced with botulinum toxin. This means that even without spasms, they have difficulty opening their eyes. These patients require a period of time after the spasm to be able to open their eyelids.
-
The goal of treatment is to help patients maintain a satisfactory lifestyle and to assist both the patient and their family in living with the condition and its associated limitations. Botulinum toxin injections are currently the treatment of choice for blepharospasm. Small amounts of botulinum toxin are injected into the muscles around the eyes, primarily the orbicularis oculi and 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. Therefore, repeated treatment is necessary to maintain the effect. Surgical Approach – Myectomy : This procedure is reserved for patients resistant to treatment with botulinum toxin. It consists of partial or complete removal of the muscles responsible for eye closure, primarily the orbicularis oculi muscle. After surgery, continued botulinum toxin injections may sometimes be necessary. Botulinum toxin is not effective in the treatment of eyelid opening apraxia. In a small percentage of patients in whom the apraxia is very disabling, surgical interventions such as frontal suspension to assist eyelid opening may be necessary.
