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  • Updated 07.05.2021
  • Released 08.31.1995
  • Expires For CME 07.05.2024

Blepharospasm

Introduction

Overview

Blepharospasm is a form of focal dystonia manifested by involuntary eye closure due to excessive contractions of the eyelids. In addition, contractions of orbicularis oculi (pretarsal, preseptal, and periorbital portions) adjacent muscles, including procerus and corrugator, as well as paranasal and other facial muscles may be involved. Blepharospasm is often misdiagnosed as “dry eyes” or “nervousness.” The author of this article reviews the clinical features, pathogenesis, and treatment of blepharospasm, focusing on the use of botulinum toxin.

Key points

• Blepharospasm is a neurologic disorder classified as a focal dystonia.

• In addition to involuntary contractions of the orbicularis oculi resulting in eye closure, most patients with blepharospasm also develop contractions of other facial muscles, jaw muscles (oromandibular dystonia), and many also have associated contractions of neck muscles causing abnormal head posture or tremor (cervical dystonia).

• Botulinum toxin injection is the treatment of choice for blepharospasm and cranial-cervical dystonia.

Historical note and terminology

Involuntary facial movements have been recognized for a long time and were depicted by artists who were fascinated by how these movements distorted the facial expression. For example, the 16th century Flemish artist Brueghel painted a woman with apparent blepharospasm and involuntary jaw opening (100). Although the eponym "Meige syndrome" sometimes has been used to designate idiopathic cranial-cervical dystonia (169), this term is not appropriate because Horatio C Wood described blepharospasm and orofacial dystonia in 1887, several decades before the 1910 publication by the French neurologist's report. It was not until the 1970s that blepharospasm was recognized as a form of focal dystonia (100; 41; 04; 38; 14; 139).

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