Blepharospasm is characterized by the increased frequency of blinking and involuntary forceful closure of eyelids. It may lead to functional blindness in some cases. It is usually caused by the abnormal contraction of orbicularis oculi muscles. Blepharospasm may become worse in bright light. Like cervical dystonia, blepharospasm sometimes may be relieved by a sensory trick of placing a finger lateral to the orbit. The onset of blepharospasm is usually gradual and  women are affected more than men.

DIAGNOSIS: The diagnosis is by history and examination. History of exposure to neuroleptic or antipsychotic medications should be asked. Blephrospasm in some cases may be confused with hemifacial spasm which is  characterized by unilateral twitching of the muscles of face around the eye or mouth. However, hemifacial spasm may be bilateral sometimes. The brain scans in patients with blepharospasm are normal. There are no other diagnostic tests.

TREATMENT:  The most effective treatment is Botulinum toxin(BOTOX) injected intramuscularly. The effect of BOTOX usually lasts  for 3-4 months. The dosage required is very low as compare to cervical dystonia. Once the effect  of BOTOX wears off, the injections have to be repeated again. Some patients might have dry eyes after the BOTOX injections and artificial tears may be helpful in that case. If the excessive dose of BOTOX is injected, patients may develop drooping of eyelids but this usually recovers in a few weeks.