Lawrence G. Kass M.D.

OCULOPLASTIC & FACIAL

COSMETIC SURGERY


727.522.3223

St. Petersburg / Clearwater

Blepharospasm Treatment

St. Petersburg / Clearwater Blepharospasm


Blepharospasm is an involuntary squeezing of the eyelids.


Although the first records of blepharospasm date back to the 16th century, it was not until the late 20th century that physicians recognized that this debilitating movement disorder was truly of neurologic origin. Before this, physicians assumed that this was a psychiatric problem.


In its early stages, blepharospasm is usually misunderstood by the afflicted patient and his/her family and even may be misdiagnosed once the patient consults a physician. The disorder begins with frequent blinking, and patients may complain of their eyes being sensitive to light, feeling dry, and feeling like there is something in them. These symptoms progress over a variable period to include involuntary unilateral spasms, which later usually involve both sides of the face. Patients may report that they are disabled to the point where they have stopped watching television, reading, driving, and/or walking. A family history positive for dystonia or blepharospasm further aids in the diagnosis.


Blepharospasm usually involves both sides of the face but a related condition, hemifacial spasm, involves only one side. Most of the time, blepharospasm occurs by itself and doctors cannot find any other nerve or brain problem.


Blepharospasm can result in prolonged eyelid closure and severe visual disability. It can also be very emotionally upsetting to the patient when the contractions occur in social settings and cannot be controlled.



Treatment


Blepharospasm is a chronic condition, which too often progressively worsens. Although no cure currently exists, patients have excellent treatment options. Since the disease frequently progresses despite treatment, patients may become frustrated and resort to unconventional remedies, sometimes becoming the victims of charlatans.


The first line of treatment for all patients should address the sensory limb or the eye-related causes which may contribute to the blepharospasm vicious cycle. Such measures include wearing tinted sunglasses with ultraviolet blocking to decrease the poorly understood cause of painful light sensitivity (photo-oculodynia). Lid hygiene to decrease irritation and blepharitis (inflammation of the eyelids) should be encouraged. Frequent applications of artificial tears and sometimes even occluding the tear drainage system (punctal occlusion) to alleviate dry eyes often improve symptoms.


Fortunately, there now is an answer to this common problem. An injection, performed in minutes in the office by a trained medical specialist, may result in complete reversal of symptoms. Patients are usually well satisfied with this treatment which is covered by most insurance plans and by Medicare.


Botulinum A toxin, or Botox, is regarded as the most effective treatment of choice for the rapid but temporary treatment of orbicularis spasm. More than 95% of patients with blepharospasm report significant improvement with use of the toxin. Although Botulinum A toxin is the product of the bacteria and once was the cause of botulinism, its use for the treatment of blepharospasm is perfectly safe and is highly effective.


Although Botox is now widely known and used as a wrinkle treatment, it was originally developed to treat blepharospasm and related dystonias or movement disorders in the late 1980's. Before this, the treatment of these debilitating disorders were usually disappointing and ineffective. Therefore, the development of Botox represented a truly giant leap forward by modern medicine.


Unlike the use of Botox for wrinkle treatment, its use for the treatment of blepharospasm and related diseases are usually covered by your medical insurance.