What is it?
Blepharospasm is the sudden and involuntary closing of both eyelids (the eyelids twitch and close).
Types of blepharospasm
Three types can be distinguished:
1. Eyelid tremor: The eyelid “trembles” (small, rapid, and involuntary movements). This movement does not affect vision. They are relatively common and are associated with situations of fatigue or stress. It is a very mild phenomenon, which usually disappears with rest. In those cases that are more persistent, it is recommended to go to the ophthalmologist.
2. Essential blepharospasm: In this condition, one or both eyelids close frequently and involuntarily. The painting can last from a few seconds to hours. The most serious and / or advanced pictures can occur with a closure of the eyelids so firm that it prevents vision. This continuous closure of the eyelids has a negative impact on the quality of life of the patient, since it prevents daily tasks such as driving, reading, working, etc.
3. Hemifacial spasm: It is a picture that occurs with the contraction of the muscles on one side of the face. The spasms can begin in the area near the eye, to later spread to other facial regions (of the face). In advanced cases, hemifacial spasms can last from several days to a few months.
Causes
Its cause is usually unknown. It affects women more than men and has a tendency to occur in members of the same family.
Blepharospasm has been related to nerve impulse disturbances, but its cause has not been fully clarified. In the case of hemifacial spasms, the cause appears to be compression of the facial nerve by a blood vessel.
Symptoms
Symptoms of blepharospasm are uncontrolled and constant blinking, as well as involuntary closing of the eye. In severe cases, the affected person cannot open their eyes. Spasms can be made worse by fatigue, bright light, and anxiety.
Diagnosis
The diagnosis is basically clinical. The most advanced cases can be easily diagnosed with the naked eye. For incipient cases, an ophthalmological consultation is indicated with special attention to the anterior segment, palpebral dynamics, in addition to ruling out neurological pathology.
Prognosis
In milder cases (tremor), the prognosis is good. The most serious cases (those whose intensity and duration is greater) can cause significant functional disability (the patient can become functionally blind, presenting great difficulties in performing daily activities, such as reading, driving and / or working). In the case of hemifacial spasms, if they are intense, they can make it difficult to speak or eat.
Treatment
There are some therapeutic alternatives. Currently, the treatment of choice is injections of botulinum toxin A. Botulinum toxin A is a neurotoxin that causes muscle paralysis, which, from a clinical point of view, blocks the activity of the eyelid muscles, which prevents constant blinking. Small doses of botulinum toxin A are administered to the periorbital muscles (around the eyes), mainly the orbicularis oculi and corrugator muscles. The effects of the treatment become visible between 24 hours and two weeks, but its duration is limited in time, approximately 3 months.
If there is any contraindication for the administration of botulinum toxin (allergy, alterations of the neuro-muscular plaque, infection of the injection area), there are other therapeutic alternatives; such as medical treatment (anticholinergics), although finding the best combination of drugs, indicated in each case, requires a long time of testing by the ophthalmologist. If medical treatment and / or botulinum toxin injection don’t work, the only viable option is surgery. There are two common types of surgery for essential blepharospasm. One technique is to remove the facial muscle causing the spasms. The other is to remove a portion of the nerve so that the spasms are not so severe.
In the case of hemifacial spasm, treatment with botulinum toxin injections can be successful in most patients. However, in those cases where the administration of botulinum toxin is contraindicated or has not been effective, the indicated treatment is an operation called microvascular decompression. This consists of placing a small sponge between the facial nerve and an artery that may be rubbing it. This type of surgery can usually correct the problem.
