Blepharitis is inflammation of the eyelids. This condition may result in an unstable or oily tear film. Typical symptoms may include: excessive matter on the eyelids or in the eyes upon awakening; a gritty feeling in the eyes; a burning sensation that is worse while reading, driving, watching TV, working at the computer, or periods of concentration; a blurry vision that “comes and goes”; itchy eyelids; and red and irritated eyelids. Blepharitis is a chronic problem that may wax and wane throughout your life, typically worsening over time if left untreated.
Dry eye syndrome is an ocular surface condition in which there is a decrease in the quality or quantity of tears, resulting in drying out of the ocular surface causing discomfort, visual disturbance, secondary tearing, or a foreign body sensation.
- Management of Dry Eye in Blepharospasm – Soparkar – 2017
- Lenses for Dry Eye – Hemmati – 2020
- Mastering Tear Supplements – Patrinely – 2019
- Understanding Dry Eye Disease – Sami – 2014
- Dry Eye Associated with BEB – Dr Yen – 2011
- Cataract Surgery and Blepharospasm & Dry Eyes – Soparker – 2013
- New Treatment for Dry Eyes – Weikert – 2019
- BEB & Dry Eye – Soparkar – 2017
- Lenses for BEB & Dry Eyes – Hemmati – 2019
- Relationships of BEB & Dry Eye – Pelak – 2016
Managing Dry Eye with speakers Rebecca Petris & Charlene Hudgins
Meige Syndrome – Oromandibular Dystonia
Meige syndrome is a form of facial dystonia named after Henri Meige. It is commonly referred to as Meige syndrome but properly referred to as oromandibular dystonia or cranial dystonia. Oromandibular Dystonia generally includes blepharospasm as part of the uncontrolled facial movements that define it; symptoms include forceful contractions and thrusts in the mouth, jaw, or tongue causing difficulty in opening and closing the mouth and can affect chewing and speech.
- Meige Syndrome – Ledoux – 2008
- Treatment: BEB & OD – Jinnah – 2018
- Oromandibular Dystonia: A Clinical Examination of 2,020 Cases – Scorr – 2021
- Long-term outcome of pallidal stimulation for Meige syndrome – Horisawa – 2019
Hemifacial Spasm (HFS)
Hemifacial spasm is a neuromuscular disorder characterized by spasming seen on only one side of the face; this is not dystonia but rather thought to be caused by compression of the facial nerve; treatment is sometimes similar to BEB with botulinum toxin injections; surgery called Microvascular Decompression might relieve symptoms for some patients. HFS can be confused with BEB but is in fact a different disorder.
One of the major differences between BEB and hemifacial spasm is that for BEB patients, the spasms usually stop when sleeping; for hemifacial spasm patients, the symptoms do not generally stop when sleeping.
- Microvascular Decompression for Hemifacial Spasm – Jones – 2013
- The Preoperative Evaluation of the Patient Considering Microvascular Decompression for Hemifacial Spasm – Sekula – 2011
- Hemifacial Spasm – Casey – 2010
- Non-Invasive Treatment – Rao – 2015
- Clinical Features – Jankovic – 2009
- MVD for Treatment of HFS – Janetta – 2002
Apraxia of eyelid opening is sometimes present and can complicate the diagnosis and treatment of blepharospasm. It is a neurological condition characterized by difficulty keeping the eyes open because the muscles that open the eyes don’t work, not because of spasms of the muscles that close the eyes.
Photophobia (sensitivity to light) is also a common ailment suffered by blepharospasm patients.
Similar but Unrelated Facial Movement Disorders
There are some disorders that appear similar to blepharospasm, either in appearance or in symptoms, but that is actually not blepharospasm. A few of the more common ones are:
Sjogren’s syndrome is a disorder of the immune system identified by its two most common symptoms — dry eyes and a dry mouth. The condition often accompanies other immune system disorders, such as rheumatoid arthritis and lupus. In Sjogren’s syndrome, the mucous membranes and moisture-secreting glands of the eyes and mouth are usually affected first — resulting in decreased tears and saliva. Although a person can develop Sjogren’s syndrome at any age, most people are older than 40 at the time of diagnosis. The condition is much more common in women. Treatment focuses on relieving symptoms.
Trichiasis is a medical term for abnormally positioned eyelashes that grow back toward the eye, touching the cornea or conjunctiva. This can be caused by infection, inflammation, autoimmune conditions, congenital defects, eyelid agenesis (the failure of an organ to develop during embryonic growth and development due to the absence of primordial tissue), and trauma such as burns or eyelid injury. It is the leading cause of infectious blindness in the world.
Eyelid Twitches and Similar Conditions
Facial tics involve spasms in muscles surrounding the eye causing forced eyelid closure. The key difference from blepharospasm is in the patient history in which patients describe the urge to have these movements (similar to an urge to sneeze), and they are sometimes able to suppress the movements for brief periods.
Facial chorea describes involuntary movements flowing from one part of the body to another at times causing forced eyelid closure. The key difference from blepharospasm is that the movements are not patterned and not always symmetrical.
Facial tremor is the involuntary movement of the face in a tremoring manner. The key difference from blepharospasm is that the movements do not involve the muscles around the eye to cause blinking, spasm, or lid incoordination.
Lid ptosis is another involuntary eyelid closure. This happens when the levator muscle stretches or separates away from the eyelid. This can be caused by aging or an eye injury. Sometimes ptosis happens as a side effect after certain eye surgery. Rarely, diseases or tumors can affect the eyelid muscle, causing ptosis.
Myokymia is an involuntary, spontaneous, localized quivering of a few muscles or bundles within a muscle. Myokymia is commonly used to describe an involuntary eyelid muscle contraction, typically involving the lower eyelid or less often the upper eyelid. It is generally not symmetrical. It occurs in normal individuals and usually starts and disappears spontaneously. However, it can sometimes last up to three weeks. Since the condition most often resolves itself, medical professionals do not consider it to be serious or a cause for concern.
Myasthenia Gravis is characterized by weakness and rapid fatigue of any of the muscles under your voluntary control. It’s caused by a breakdown in the normal communication between nerves and muscles. It is sometimes confused with blepharospasm