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Findings
- Uncontrolled bilateral, episodic blinking, twitching, or closing of the eyelids (contractions of the orbicularis muscle)
- Disappears during sleep
- Meige syndrome: combined with spasms of the lower facial muscles, jaw, and throat area
- Note: Severe cases can lead to functional blindness, affecting driving capability
- Sometimes associated with apraxia of lid opening.
Work-up
- History: Unilateral or bilateral? Only eyes or also face or the rest of the body affected? Medications?
- Slit lamp examination: Dry eyes, blepharitis, foreign bodies.
- Neuro-ophthalmological examination: Any accompanying abnormal findings?
- For typical blepharospasm: No routine imaging necessary
- For atypical cases: Neurological consultation
Treatment
- treat dry eye / blepharitis
- In severe cases: Botulinum toxin injections in/around eyelids (in orbicularis muscle)
- Consider orbicularis myectomy in therapy-resistant patients
Differential Diagnoses
- Eyelid twitching (fasciculation): Unilateral, very discreet, influenced by dry eyes, stress, caffeine, etc., usually self-limiting.
- Hemifacial spasm: Unilateral, does not disappear during sleep, may be caused by compression of the facial nerve (MRI!).
- Surface problems of the eye, dry eye, inflammations
- Apraxia of Eyelid Opening
- Tardive dyskinesia
- Tourette syndrome
Sources
- EyeWiki – Blepharospasm
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Kalla Gervasio MD, Travis Peck MD et al; Lippincott Williams&Wilkins; 8th Edition(2021)
- Ip C. W. et al., Dystonie, S1-Leitlinie, 2021, in: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. Online: www.dgn.org/leitlinien (visited on 10.04.2022)