What is Blepharospasm?
Blepharospasm, also known as essential blepharospasm, is the medical name for a neurologic condition which causes both eyes to involuntary close. In other words, blepharospasm is an abnormal contraction of the eye muscles. Typically, blepharospasm affects both sides of the face, although one side is often more severe. Patients with blepharospasm have normal vision, but in severe cases, these spasms can result in functional blindness.
In addition, patients can suffer from a similar spasm that also affects vision. A hemifacial spasm, caused by a nervous system disorder, is a medical condition that causes unilateral facial twitching, which can be very visually bothersome. Both of these conditions cause involuntary contraction of facial muscles.
What Causes Eyelid Twitching?
There are two types of blepharospasm, primary and secondary. Primary, or essential blepharospasm, develops spontaneously, is not life-threatening, and is of unknown cause. While the cause is unknown, essential blepharospasm is generally believed to be an acquired imbalance in the activity of brain cells at involuntary levels deep in the brain. The cause is frequently Meige’s syndrome or oromandibular dystonia. Dystonias are characterized by involuntary twisting, pulling, or squeezing movements. In contrast, patients can typically connect their secondary blepharospasm to a cause such as exposure to certain drugs or in connection to other disorders such as Parkinson’s disease or Wilson’s disease.
Hemifacial spasm has a different cause than essential blepharospasm, as a generally one-sided, intermittent, high-frequency contracture of the facial muscles. The cause is believed to be a blood vessel that compresses the facial nerve as it exits the brain. Although it can be treated with a neurosurgical procedure to decompress the nerve within the brain, this treatment also carries some severe risks, so only a few patients tend to pursue it.
How do you diagnose blepharospasm?
Presently, there is no test specifically for blepharospasm. When you come in for a consultation, Dr. Holds will diagnose blepharospasm using patient history, a physical examination, and a neurological evaluation. It is important to receive a diagnosis from a qualified physician such as Dr. Holds, to be sure that you have blepharospasm and not another condition.
Types of Treatment for Eye Spasms
Since blepharospasm treatment is generally medically necessary Medicare or other insurance plans sometimes cover it. Treatment methods can involve a number of techniques, including biofeedback and relaxation techniques, and oral drug therapies. However, patients seldom use oral medications and other techniques, as few achieve relief from them.
Fortunately, Dr. Holds has over 20 years of experience in treating thousands of patients with essential blepharospasm and hemifacial spasm. He has researched this disease, written multiple medical papers about it, and has taught courses to other physicians and patients regarding these treatments. He has a referral base for these patients which extends nationally, and he is recognized as a well-known authority in the treatment of these conditions. Dr. Holds prefers to use one of two treatment methods:
- Myectomy surgery
Botox for Blepharospasm
Botox is one treatment method for blepharospasms and benefits 95% of patients. Dr. Holds injects Botox right into the problem muscles, essentially relaxing them and preventing them from spasming. Most of our patients receive a topical anesthetic cream specific to our practice which relieves the tiny needle-prick involved. The Botox treatment results typically last for 2-6 months. Many patients will need to return for more treatment after that time. Patients can experience some side effects from the injections such as droopy eyelids or facial droop. However, the side effects of Botox are temporary since Botox results are also temporary.
Another treatment for blepharospasm is myectomy surgery. During this procedure, Dr. Holds removes the muscles that are in spasm. This is a very intricate surgery that a relatively small number of surgeons in the United States can appropriately perform, such as Dr. Holds at Ophthalmic Plastic and Cosmetic Surgery, Inc. in St. Louis.
Myectomy is an outpatient surgery using local anesthetic and takes a few hours to complete. During the procedure, Dr. Holds will remove all or a portion of the muscle that is causing the spasm or eyelid closure problem. Most patients require simultaneous procedures to correct sagging skin, eyebrows, or eyelids. After surgery, significant bruising, swelling, and soreness may develop. Patients can take pain medication, if necessary, and should sleep with their head elevated. Dr. Holds recommends that patients apply ice packs to their eyes periodically to keep the swelling down. In addition, he may prescribe eye drops or ointments to put in your eyes for one to two weeks.