BLEPHAROSPASM

It refers to the involuntary, sustained and forceful
closure of the eyelids.
Etiology. Blepharospasm occurs in two forms:
1. Essential (spontaneous) blepharospasm. It is a
rare idiopathic condition involving patients
between 45 and 65 years of age.
2. Reflex blepharospasm. It usually occurs due to
reflex sensory stimulation through branches of
fifth nerve, in conditions such as : phlyctenular
keratitis, interstitial keratitis, corneal foreign body,
corneal ulcers and iridocyclitis. It is also seen in
excessive stimulation of retina by dazzling light,
stimulation of facial nerve due to central causes
and in some hysterical patients.
Clinical features. Persistent epiphora may occur due
to spasmodic closure of the canaliculi which may lead
to eczema of the lower lid. Oedema of the lids is of
frequent occurrence. Spastic entropion (in elderly
people) and spastic ectropion (in children and young
adults) may develop in long-standing cases.
Blepharophimosis may result due to contraction of
the skin folds following eczema.
Treatment. In essential blepharospasm Botulinum
toxin, injected subcutaneously over the orbicularis
muscle, blocks the neuromuscular junction and
relieves the spasm. Facial denervation may be
required in severe cases. In reflex blepharospasm, the
causative disease should be treated to prevent
recurrences. Associated complications should also
be treated.