What happens to centuries
Normally, the orbicularis oculi muscle closes the eyelids when blinking and relaxes immediately after. With blepharospasm in the subcortical nodes of the brain, control over this movement is disrupted: the command to contract is received excessively and for a long time. At first it looks like frequent blinking, then like prolonged squinting for several seconds, and in severe cases the eyes remain closed for minutes. Some patients develop apraxia of eyelid opening, when the eyelids are not closed, but the person still cannot lift them.
- Increased blinking is the earliest stage
- Prolonged squinting of both eyes
- Apraxia of eyelid opening
- Spread of spasm to the lower part of the face
- Combination with dystonia of the neck and jaw
Reasons and what provokes
Most often, blepharospasm is primary: a specific cause cannot be found; age and individual characteristics of the functioning of subcortical structures are important. Secondary forms are associated with a stroke, trauma, taking antipsychotics and antiparkinsonian drugs. A separate and very common situation is when a spasm is triggered and maintained by irritation of the eye: dryness, inflammation of the eyelid margin, uncorrected vision. Therefore, eliminating eye problems is an essential part of treatment.
- Primary eyelid dystonia without apparent cause
- Dry eyes and blepharitis
- Taking antipsychotics and some antiemetics
- Consequences of stroke and head injury
- Bright light, wind, smoke, long periods of screen time
- Stress, lack of sleep, anxiety
Symptoms and how it differs from tic
Blepharospasm is almost always bilateral, worsens in bright light and with visual stress, weakens after sleep, when singing, chewing or talking. An ordinary eyelid tic, on the contrary, is limited to twitching of the lower or upper eyelid on one side, does not interfere with vision and goes away on its own in a few days. Hemifacial spasm involves half the entire face, including the corner of the mouth, and is often associated with compression of the facial nerve by a vessel. These differences are fundamental because their treatment is different.
- Bilateral forced closure of eyelids
- Photophobia and feeling of sand in the eyes
- Relief when talking, chewing, touching the temple
- Increased when reading, driving, bright light
- No spasms during sleep
- Increasing complaints over months and years
Diagnostics
The diagnosis is clinical: the doctor observes the nature of the spasms, asks to look at the light, read, close your eyes and relax, checks for the presence of alleviating techniques. The ophthalmologist evaluates the cornea, tear film and eyelid margins to find and eliminate the source of irritation, as well as rule out glaucoma and inflammation. MRI of the brain is prescribed for unilateral spasms, rapid development, weakness or speech impairment. Be sure to check the list of medications you are taking.
- Examination by a neurologist with assessment of facial expressions and corrective gestures
- Examination by an ophthalmologist, dry eye test
- Measuring intraocular pressure
- MRI of the brain for unilateral and atypical forms
- Review of medications taken
- Electroneuromyography of facial muscles according to indications
Treatment and daily life
The main method is injection of botulinum toxin into the orbicularis oculi muscle. The procedure is performed by a doctor, the effect develops in a few days and lasts on average 3–4 months, after which the course is repeated; With proper technique, complications are rare and reversible. At the same time, be sure to treat dry eyes with moisturizing drops and eyelid hygiene. Many people benefit from dark-tinted glasses with a filter, a regime of visual stress, and adequate sleep. Tablet drugs are used less frequently, if the effect of injections is insufficient, and they are selected by a neurologist. In secondary forms, the issue of discontinuing the drug that provoked the spasm is decided.
- Botulinum therapy courses every 3–4 months
- Moisturizing drops and hygiene of the eyelid edges
- Dimmable glasses with filter
- Normalization of sleep and reduction of visual stress
- Review your medications with your doctor
- Tablet drugs with insufficient effect
- Surgical treatment in rare severe cases