Blepharospasm

Neurology

Clinicals - History

Fact Explanation
Excessive blinking Excessive and uncontrollable blinking occurs in blepharospasm. Excessive blinking
Excessive and uncontrollable blinking occurs in blepharospasm.
Twitching of the eye lids Patients complain of twitching of the muscles surrounding the eyes. This often progress to face and neck as well. Twitching of the eye lids
Patients complain of twitching of the muscles surrounding the eyes. This often progress to face and neck as well.
Difficulty in opening the eyes Patients often find it difficult to open the eyes and they may complain that they need to put a great effort to open the eyes due to spasm of the muscles surrounding the eyes. Difficulty in opening the eyes
Patients often find it difficult to open the eyes and they may complain that they need to put a great effort to open the eyes due to spasm of the muscles surrounding the eyes.
Risk factors Although the exact cause is not known in primary blepharospasm, fatigue, stress, and irritants are known risk factors of primary blepharospasm. Pain in and around the eye causes reflex blepharospasm. Patients with a history of dry eyes and sensitivity to the sun and bright light can also develop blepharospasm. Wind, air pollution, noise, and movements of the head or eyes can also cause blepharospasm. Risk factors
Although the exact cause is not known in primary blepharospasm, fatigue, stress, and irritants are known risk factors of primary blepharospasm. Pain in and around the eye causes reflex blepharospasm. Patients with a history of dry eyes and sensitivity to the sun and bright light can also develop blepharospasm. Wind, air pollution, noise, and movements of the head or eyes can also cause blepharospasm.
Blindness Functional blindness can develop in severe cases, because of the inability to open the eyes. Blindness
Functional blindness can develop in severe cases, because of the inability to open the eyes.
Drug history Patients who had neuroleptics, antihistamines, calcium channel blockers, noradrenaline and serotonin reuptake inhibitors can have blepharospasm as a side effect of treatment. Benzodiazepines (alprazolam, bromazepam, clonazepam, diazepam, ethyl loflazepate, or triazolam) can also result in blepharospasm after prolonged use and in acute withdrawal. Drug history
Patients who had neuroleptics, antihistamines, calcium channel blockers, noradrenaline and serotonin reuptake inhibitors can have blepharospasm as a side effect of treatment. Benzodiazepines (alprazolam, bromazepam, clonazepam, diazepam, ethyl loflazepate, or triazolam) can also result in blepharospasm after prolonged use and in acute withdrawal.
Photophobia Some patients may complain of photophobia which is useful in making the diagnosis of blepharospasm. Photophobia
Some patients may complain of photophobia which is useful in making the diagnosis of blepharospasm.
Irritation of the eyes This is one of the significant complain of blepharospasm. Irritation of the eyes
This is one of the significant complain of blepharospasm.
Family history Positive family history can be detected in some patients with blepharospasm. Family history
Positive family history can be detected in some patients with blepharospasm.
History of Parkinson disease Secondary blepharospasm as well as treatment with dopaminergic agents can be associated with Parkinson disease. History of Parkinson disease
Secondary blepharospasm as well as treatment with dopaminergic agents can be associated with Parkinson disease.
Psychiatric symptoms Patients can have depression and anxiety associated with blepharospasm. Psychiatric symptoms
Patients can have depression and anxiety associated with blepharospasm.
History of head trauma Some patients may develop blepharospasm after head trauma. History of head trauma
Some patients may develop blepharospasm after head trauma.

Clinicals - Examination

Fact Explanation
Frequent blinking Patients with blepharospasm blink frequently. Frequent blinking
Patients with blepharospasm blink frequently.
Narrow eye lids The eye lids of the affected patients can be narrowed or closed. Narrow eye lids
The eye lids of the affected patients can be narrowed or closed.
Muscle spasms Spasmodic and stereotyped contractions can be seen in muscles surrounding the eyes. These can not be voluntarily suppressed. Muscle spasms
Spasmodic and stereotyped contractions can be seen in muscles surrounding the eyes. These can not be voluntarily suppressed.
Sensory tricks Patients with blepharospasm can have sensory tricks, which are the manoeuvres used to relieve pain due to muscle spasms. Patient may touch or rub the eyes. Sensory tricks
Patients with blepharospasm can have sensory tricks, which are the manoeuvres used to relieve pain due to muscle spasms. Patient may touch or rub the eyes.

Investigations - Diagnosis

Fact Explanation
Electromyogram (EMG) EMG of the muscles of the eyelids (orbicularis oculi and levator palpebrae superioris) is helpful in early diagnosis of blepharospasm. Electromyogram (EMG)
EMG of the muscles of the eyelids (orbicularis oculi and levator palpebrae superioris) is helpful in early diagnosis of blepharospasm.
Functional MRI (fMRI) fMRI can demonstrate abnormal activity in the somatosensory and cingulate cortices, thalamus, caudate, cerebellum, and brainstem. Functional MRI (fMRI)
fMRI can demonstrate abnormal activity in the somatosensory and cingulate cortices, thalamus, caudate, cerebellum, and brainstem.
PET scan PET scan can also demonstrate findings similar to fMRI. PET scan
PET scan can also demonstrate findings similar to fMRI.

Investigations - Management

Fact Explanation
Renal function test Assessment of the renal function is indicated if surgical intervention is planned. Basic assessment of the renal function includes serum electrolytes and serum creatinine levels. Renal function test
Assessment of the renal function is indicated if surgical intervention is planned. Basic assessment of the renal function includes serum electrolytes and serum creatinine levels.
Full blood count Full blood count enables the diagnosis of anemia and infections. Full blood count
Full blood count enables the diagnosis of anemia and infections.
ECG ECG asseses the cardiovascular fitness of the patient. ECG
ECG asseses the cardiovascular fitness of the patient.

Management - Supportive

Fact Explanation
Health education Patients with light sensitivity are advised to wear dark glasses and hats during out door activities. This is effective as a mode of camouflage as well. Blepharospasm caused by wind can be avoided by using spectacles and by avoiding riding motor cycles. Maintenance of lid hygiene is important in treating blepharospasm if the causative factor is irritants. Patients with stress related blepharospasm can be educated to practice relaxation methods. Good quality and adequate sleep is also helpful in relieving symptoms. Health education
Patients with light sensitivity are advised to wear dark glasses and hats during out door activities. This is effective as a mode of camouflage as well. Blepharospasm caused by wind can be avoided by using spectacles and by avoiding riding motor cycles. Maintenance of lid hygiene is important in treating blepharospasm if the causative factor is irritants. Patients with stress related blepharospasm can be educated to practice relaxation methods. Good quality and adequate sleep is also helpful in relieving symptoms.

Management - Specific

Fact Explanation
Withhold the offending drug Drug induced blepharospasm usually resolve with the cessation of the offending drug. Withhold the offending drug
Drug induced blepharospasm usually resolve with the cessation of the offending drug.
Medical management Anticholinergics (trihexyphenidyl, benztropine, biperiden, atropine) are indicated for the medical management of blepharospasm. They are known to inhibit the nicotinic acetylcholine receptors in the skeletal muscles which inhibit the propagation of the nerve impulse causing muscle relaxation. Medical management
Anticholinergics (trihexyphenidyl, benztropine, biperiden, atropine) are indicated for the medical management of blepharospasm. They are known to inhibit the nicotinic acetylcholine receptors in the skeletal muscles which inhibit the propagation of the nerve impulse causing muscle relaxation.
Botulinum toxin injections Botulinum toxin is injected to induce localized, partial paralysis of the affected muscles. Botulinum toxin injections
Botulinum toxin is injected to induce localized, partial paralysis of the affected muscles.
Surgery If the patient is not responding to both medical management and to botulinum toxin injections, protractor myectomy, bilateral facial nerve avulsions are done. Surgery
If the patient is not responding to both medical management and to botulinum toxin injections, protractor myectomy, bilateral facial nerve avulsions are done.
Ganglion block Ganglion block can be done by injecting botulinum toxin in to the ganglion, which inhibits the transmission of nerve impulses. Ganglion block
Ganglion block can be done by injecting botulinum toxin in to the ganglion, which inhibits the transmission of nerve impulses.
Nerve block By blocking the selected nerve fibers of the facial nerve, spasmodic contractions of the muscles can be abolished. Nerve block
By blocking the selected nerve fibers of the facial nerve, spasmodic contractions of the muscles can be abolished.

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  1. AQUINO CC, FELíCIO AC, CASTRO PC, OLIVEIRA RA, SILVA SM, BORGES V, FERRAZ HB. Clinical features and treatment with botulinum toxin in blepharospasm: a 17-year experience. Arq Neuropsiquiatr [online] 2012 Sep, 70(9):662-6 [viewed 12 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22990720
  2. DEFAZIO G, HALLETT M, JINNAH HA, BERARDELLI A. Development and validation of a clinical guideline for diagnosing blepharospasm Neurology [online] 2013 Jul 16, 81(3):236-240 [viewed 13 September 2014] Available from: doi:10.1212/WNL.0b013e31829bfdf6
  3. DIGRE KB, BRENNAN KC. Shedding Light on Photophobia J Neuroophthalmol [online] 2012 Mar, 32(1):68-81 [viewed 12 September 2014] Available from: doi:10.1097/WNO.0b013e3182474548
  4. EMOTO Y, EMOTO H, OISHI E, HIKITA S, WAKAKURA M. Twelve cases of drug-induced blepharospasm improved within 2 months of psychotropic cessation Drug Healthc Patient Saf [online] :9-14 [viewed 12 September 2014] Available from: doi:10.2147/DHPS.S20691
  5. FLEISHER LA. The Preoperative Electrocardiogram: What Is the Role in 2007? Ann Surg [online] 2007 Aug, 246(2):171-172 [viewed 13 September 2014] Available from: doi:10.1097/SLA.0b013e31811eb927
  6. GRANDAS F, ELSTON J, QUINN N, MARSDEN CD. Blepharospasm: a review of 264 patients. J Neurol Neurosurg Psychiatry [online] 1988 Jun, 51(6):767-772 [viewed 12 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1033145
  7. HWANG WJ. Demographic and clinical features of patients with blepharospasm in southern Taiwan: a university hospital-based study. Acta Neurol Taiwan [online] 2012 Sep, 21(3):108-14 [viewed 12 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23196730
  8. KHOOSHNOODI MA, FACTOR SA, JINNAH HA. Secondary Blepharospasm Associated with Structural Lesions of the Brain J Neurol Sci [online] 2013 Aug 15, 331(0):98-101 [viewed 12 September 2014] Available from: doi:10.1016/j.jns.2013.05.022
  9. KUMAR A, SRIVASTAVA U. Role of routine laboratory investigations in preoperative evaluation J Anaesthesiol Clin Pharmacol [online] 2011, 27(2):174-179 [viewed 13 September 2014] Available from: doi:10.4103/0970-9185.81824
  10. LIM SJ, PARK HJ, LEE SH, MOON DE. Ganglion Impar Block With Botulinum Toxin Type A for Chronic Perineal Pain -A Case Report- Korean J Pain [online] 2010 Mar, 23(1):65-69 [viewed 12 September 2014] Available from: doi:10.3344/kjp.2010.23.1.65
  11. PARDAL-FERNáNDEZ JM, MANSILLA-LOZANO D. [Value of simultaneous electromyographic recording of the levator palpebrae and the orbicularis oculi muscles as an early diagnostic marker for blepharospasm]. Rev Neurol [online] 2012 Dec 1, 55(11):658-62 [viewed 12 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23172092
  12. PECKHAM EL, LOPEZ G, SHAMIM EA, RICHARDSON SP, SANKU S, MALKANI R, STACY M, MAHANT P, CRAWLEY A, SINGLETON A, HALLETT M. Clinical features of patients with blepharospasm: a report of 240 patients. Eur J Neurol [online] 2011 Mar, 18(3):382-6 [viewed 12 September 2014] Available from: doi:10.1111/j.1468-1331.2010.03161.x
  13. SANCHEZ-CAPUCHINO A, MEADOWS D, MORGAN L. Local anaesthesia for eye surgery without a facial nerve block. Anaesthesia [online] 1993 May, 48(5):428-31 [viewed 13 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8317654
  14. TRUONG DD, GOLLOMP SM, JANKOVIC J, LEWITT PA, MARX M, HANSCHMANN A, FERNANDEZ HH, XEOMIN US BLEPHAROSPASM STUDY GROUP. Sustained efficacy and safety of repeated incobotulinumtoxinA (Xeomin®) injections in blepharospasm J Neural Transm [online] 2013, 120(9):1345-1353 [viewed 12 September 2014] Available from: doi:10.1007/s00702-013-0998-9