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What is Blepharospasm?
Blepharo means "eyelid". Spasm means "uncontrolled muscle contraction". The term blepharospasm can be applied to any abnormal blinking or eyelid tic or twitch resulting from any cause, ranging from dry eyes to Tourette's syndrome to tardive dyskinesia. The blepharospasm referred to here is officially called benign essential blepharospasm. Patients with blepharospasm have normal eyes. The visual disturbance is due solely to the forced closure of the eyelids.
Blepharospasm should not be confused with:
Ptosis - drooping of the eyelids caused by weakness or paralysis of a levator muscle of the upper eyelid
Blepharitis - an inflammatory condition of the lids due to infection or allergies
Hemifacial spasm - a non-dystonic condition involving various muscles on one side of the face, often including the eyelid, and caused by irritation of the facial nerve. The muscle contractions are more rapid and transient than those of blepharospasm, and the condition is always confined to one side.
Botulinum Toxin for Treatment of Blepharospasm
Botulinum toxin is an approved treatment for blepharospasm and hemifacial spasm in the United States and Canada. This is a toxin produced by the bacteria Clostridium botulinum. It weakens the muscles by blocking nerve impulses transmitted from the nerve endings of the muscles. When it is used to treat blepharospasm, minute doses of botulinum toxin are injected intramuscularly into several sites above and below the eyes. The sites of the injection will vary slightly from patient to patient and according to physician preference. They are usually given on the eyelid, the brow, and the muscles under the lower lid. The injections are carried out with a very fine needle. Benefits begin in 1 - 14 days after the treatment and last for an average of three to four months. Long-term follow-up studies have shown it to be a very safe and effective treatment, with up to 90 percent of patients obtaining almost complete relief of their blepharospasm. Side effects include drooping of the eyelid (ptosis), blurred vision, and double vision (diplopia). Tearing may occur. All are transient and recover spontaneously. Providing the dose is kept small and the injections carried out at a minimum of three-month intervals, repeated treatments remain effective over a long period of time.
Patients and physicians should familiarize themselves with the most current Contraindications, Warnings, Precautions and Adverse Effects on the product inserts and the manufacturers' sites. One point particularly worth noting is that botulinum toxin may be contraindicated for patients with any type of condition that causes muscle weakness.