Benign Essential Blepharospasm

Leonid Skorin, Jr, DO

Eyelid spasms and uncontrolled blinking impaired a 75-year-old man's ability to ambulate and to drive. Bright light aggravated the spasms.

Eyelid spasms and uncontrolled blinking impaired a 75-year-old man's ability to ambulate and to drive. Bright light aggravated the spasms.

This patient had benign essential blepharospasm, a focal dystonia of the eyelids that is diagnosed clinically. Affected persons have a history of progressive, uncontrolled, bilateral blinking that initially may affect only one eye. Over time, the blinking erupts in spasms.

The condition affects the orbicularis oculi, procerus, and corrugator supercilii musculature. Women are affected more often than men; the disease process is progressive and bilateral and, as in this patient, may lead to functional blindness.

The most effective therapy is injection of botulinum A toxin. The effects last for an average of 3 to 4 months; additional injections can be given when symptoms recur. Surgical myectomy may be helpful for those who do not respond to botulinum injections.