EpistemisBlepharospasm
Specialty: Neurology.
Why it occurs
- Benign essential blepharospasm (facial focal dystonia)
- Meige syndrome (craniofacial dystonia combined with oromandibular spasm)
- Local eye irritation (keratoconjunctivitis, trichiasis, severe dry eye)
- Adverse effect of neuroleptics and dopaminergic drugs
- Structural lesions of the brain stem or basal ganglia (infarcts, demyelination)
Initial workup
Detailed neurological and ophthalmological clinical evaluation; electromyography (EMG) of the orbicularis oculi muscles to observe synchronous dystonic discharges; magnetic resonance imaging (MRI) of the brain with emphasis on the posterior fossa to rule out microvascular compressions or structural lesions in the path of the seventh cranial nerve.
red flags
Association with persistent ipsilateral peripheral facial paralysis (suggests compressive injury to the facial nerve in the cerebellopontine angle), rapidly progressive involvement of other muscle groups, or absolute inability to open the eyes voluntarily leading to significant functional blindness with risk of falls.
Standard management
- Botulinum toxin type A — of choice, infiltrated directly into the pretarsal and orbital portions of the orbicularis oculi muscle every 3-4 months
- Clonazepam — 0.5-2 mg/day, as adjuvant therapy to modulate neuronal excitability
- Trihexyphenidyl (2-6 mg/day, anticholinergic useful in refractory focal dystonias).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 3