Blepharospasm

At a Blepharospasm eyelid cramp occurs in one or both eyes. The cramp cannot be influenced by those affected.

What is blepharospasm?

Blepharospasm is a voluntary spasm of the eyelids. It can occur on one side of the eye or on both sides.

Blepharospasm is a voluntary spasm of the eyelids. It can occur on one side of the eye or on both sides. The eyelid cramp is not manageable for the patient and manifests itself primarily in the orbicularis oculi muscle (eye ring muscle) and in some neighboring muscles. Blepharospasm has a significant impact on the facial expressions of those affected.

A distinction must be made between three different forms of blepharospasm: the classic blepharospasm, the tonic blepharospasm and the type of lid opening inhibition. The classic blepharospasm is a clonic eyelid spasm that occurs repeatedly, while the tonic eyelid spasm is a permanent contraction. This results in a persistent narrowing of the eyelid gap.

The eyelid opening inhibition type is used when the contraction does not appear on the eye ring muscle but on the forehead muscle. The eye opening is disrupted. Blepharospasm is a rare disease. In Europe, three or four in 100,000 people suffer from it. It is most common in women of middle or older age.

causes

Blepharospasm is caused by cramping of the eyelid muscle. A differentiation is made between a primary and a secondary form. For the primary form, too essential blepharospasm called, no cause could be found so far. All that is known is a disruption in the interaction of different chemical substances within the basal ganglia of the brain. However, it has still not been possible to determine what causes these disturbances.

External factors or the psyche also play a role. The spasm occurs in numerous patients after emotional stress. If those affected go to rest, the symptoms subside again. But bright light, walking or drafts can also trigger eyelid cramps. The secondary form is called symptomatic blepharospasm and is caused by certain diseases or disorders. These are diseases of the eyes or nerves or damage to the central nervous system. However, the primary form is more common than the secondary blepharospasm.

At a idiopathic blepharospasm, the cause of which is unknown, people suffer from eyelid spasm on both sides of their eyes. Usually it starts with an excessive blink. Typical triggers are emotional stress, fatigue and bright light stimuli. As the eyelid cramp progresses, the symptoms worsen. In some cases they are so intense that the eyes close for several hours. The symptoms usually subside at night. The symptoms are much less pronounced in the morning than in the evening hours.

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Diseases with this symptom

• Corneal inflammation
• Ataxia
• Spasticity
• Eye migraines

• Dystonia
• Eye diseases
• botulism
• Ptosis

• Conjunctivitis
• Inflammation of the eyelid
• migraine
• Ectropion

Diagnosis & course of disease

If blepharospasm is suspected, a doctor should be consulted. The best place to go is a neurologist. This is the best way to assess and treat the eyelid cramp. Ophthalmologists, on the other hand, do not always notice blepharospasm at the first examination. The doctor first looks at the patient's medical history. So he asks how long the symptoms have existed and whether there are any underlying diseases.

During the subsequent examination of the eyes, he determines the blink frequency. Normally this is 10 to 20 times per minute. If the patient has blepharospasm, the blinking occurs at least 27 times per minute. Electromyography (EMG) can be used to measure the electrical activity of the eye ring muscle and other muscles. Magnetic resonance imaging (MRI) can be used to determine the causes of secondary blepharospasm.

It is also important to rule out other causes that cause eyelid spasm. Blepharospasm can have a significant impact on the quality of life of those affected, which in turn has negative consequences for the psyche. Functional blindness is also possible. Basically, however, eyelid spasm can be treated well.

Complications

Blepharospasm and the therapies used to treat eyelid disease can cause a number of complications. The disease itself sometimes leads to severe pain and cramps in the area of ​​the eyes, which become more intense over time and greatly increase the suffering for those affected. The dystonic movement disorders lead to cramps and pain in the muscles, injuries or cramps also occur and in turn bring a number of complications with them.

In the worst case, blepharospasm leads to a persistent narrowing of the eyelid gap and ultimately to functional blindness. The psychological burden is usually just as great for those affected, which is why complications are not uncommon here either. A wide variety of complications can arise in the course of therapeutic measures, depending on the treatment. Treatment with botulinum toxin, for example, typically leads to increased tearing up to diplopia and can also trigger headaches and sensitivity to light. Depending on the constitution and age of the patient, the formation of hematomas, accompanied by local pain, is possible.

The most common side effects of the anticholinergics used include forgetfulness, constipation, dry mouth and blurred vision. If treatment for blepharospasm fails, these symptoms may worsen, depending on the drug used and the patient's medical history. Due to the possible complications, comprehensive therapy and neurological follow-up of the symptoms are necessary.

When should you go to the doctor?

Blepharospasm is a spasm of the eyelids. The eyelid cramp can occur in one or both eyes. The eye ring muscle and a few of its neighboring muscles are mainly responsible for this. Sufferers cannot control their blepharospasm.

Since the phenomenon severely affects their facial expressions and thus their communication with other people, blepharospasm is not only a physical but also a psychological problem. To make matters worse, blepharospasm is an extremely rare disease that most people experience is unknown. What is noticeable about blepharospasm is its accumulation in women of middle and advanced age.

If blepharospasm occurs, it is not necessary to see an ophthalmologist, but a neurologist. He is more familiar with this disorder in the eye than an ophthalmologist, has the appropriate diagnostic tools at hand and is also better able to treat blepharospasm. Electromyography (EMG), for example, is used to measure the electrical eye ring muscle and neighboring muscle activities, as well as magnetic resonance imaging (MRT), which is already known to many patients from other examinations.

Botulinum toxin - also known under the name of botox - can also be used by neurologists to combat blepharospasm. Therapy for blepharospasm is often complicated and lengthy. It demands patience and optimism from the patient. Later follow-up appointments are also important.

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Treatment & Therapy

If there is a secondary blepharospasm, the treatment of the underlying disease is the main focus. Since the causes of the primary form are unknown, treating them is more difficult. Medicines such as benzodiazepines or muscle relaxants usually hardly bring any improvement. There is also the risk of severe side effects. For this reason, injections with the neurotoxin botulinum toxin A are usually given.

The patient receives the injection under the skin directly into the eye ring muscle. The botulinum toxin results in paralysis. The dose is initially low in order to avoid bothersome side effects. The injection is usually given in four places around the eye. The doctor then adjusts the injection areas and dosage individually to the patient. Since the effect wears off after a certain time, the treatment must be carried out again about every three months.

The main side effects are turning the eyelid outward (ectropion) or drooping (ptosis). Some patients may also need an operation in which nerve fibers of the facial nerve (facial nerve) are cut. The eye muscle can also be partially removed.

Outlook & forecast

In the event of blepharospasm, a doctor must be consulted immediately. In most patients, the disease increases the frequency of blinking so that they blink every two seconds on average. This can also trigger a cramp in the eyelid, which is described as painful.

Blepharospasm reduces the quality of life of the person concerned relatively strongly and can also lead to psychological problems or limitations. However, the symptom itself can be treated well. The cramp and paralysis are released by the doctor with the help of a syringe, so that the pain also subsides. In most cases, this will require four syringes. Depending on the severity of the blepharospasm, the injections must be repeated after a certain time. A quarterly rhythm is suitable here.

The eyelid is changed by blepharospasm. For example, it may hang down or wander up after treatment. Usually this cannot be predicted. This symptom can also be treated with surgery. The muscle itself can also be completely removed if necessary.

The sufferer should watch out for and avoid stressful situations with blepharospasm. Likewise, prolonged watching TV or working on the computer promotes the symptom and should be avoided if possible. Treatment usually leads to a positive course of the disease.

You can find your medication here

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prevention

No specific preventive measures against blepharospasm are known. Patients are advised not to watch TV for too long and avoid strong sunlight. It is also helpful to wear darkened sunglasses that protect against bright light.

You can do that yourself

Blepharospasm is not a disease that can be healed. On the contrary, the symptoms of the disease can increase very sharply over a longer period of time. Therefore, a visit to the doctor should not be avoided. The disease can be recognized very well at an early stage so that treatment can be prescribed quickly.

In the meantime, stressful situations and other stressful everyday events should be avoided. A reduction in stress is often accompanied by an alleviation of the symptoms. Typical relaxation exercises or a soothing tea can have a very relieving effect. There are a variety of relaxation techniques that can be used to slow down: Slow gymnastic exercises from yoga or breathing exercises from Buddhist meditation practice can help to direct the pent-up excitement out of the body. If Far Eastern, spiritual exercises do not correspond to the taste, relaxation exercises from conventional medicine such as autogenic training can also be used.

However, it should also be noted that complete healing cannot be guaranteed through relaxation units. The ophthalmologist should therefore check whether surgery and / or drug treatment is necessary.