Diseases

Blepharospasm - eye cramp

Blepharospasm - eye cramp


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Involuntary eyelid cramps

Blepharospasm (eyelid cramp) summarizes various forms of muscle cramps on the eyelid. Mostly it is a recurring, bilateral, cramp-like lid closure. As a rule, the disease first manifests itself through an increased blinking. In the further course, there are recurring and long-lasting eyelid cramps. Stress and other external factors can make the symptoms worse. The causes are still unknown and a permanent cure of the disease is not possible. The most common agent for the treatment of blepharospasm is the neurotoxin botulinum toxin (botox).

A brief overview

The following overview briefly summarizes the following article on the clinical picture and possible treatment options for blepharospasm:

  • Definiton: Blepharospasm is a movement disorder caused in the brain that leads to involuntary contractions of the eye muscle and thus to eyelid cramps.
  • Symptoms: The first sign of the disease is an increased blinking, which later develops into uncontrollable and differently strong eyelid cramps, which can occur temporarily or permanently.
  • causes: The causes are mostly unknown and are suspected in the central nervous system. Rarely are other diseases, side effects of medication or foreign objects in the eye the triggers.
  • diagnosis: In addition to a thorough examination of the eyes, a precise diagnosis and the exclusion of other diseases require a determination of the blinking frequency and the corresponding muscle activities. Sometimes possible disorders in the nervous system are investigated to determine the cause.
  • treatment: The drug of choice in most cases is botulinum toxin, which is administered via subcutaneous injections at an interval of approximately three months. Other treatments are less successful.
  • Naturopathic treatment: Complementary stress reduction and muscle relaxation measures, such as acupuncture, meditation or autogenous training, can help alleviate the symptoms.

Definition

The term blepharospasm comes from Greek and means loosely translated cramp. The terms blink cramp and blepharism are also used less often for this disease. Blepharospasm is assigned to the so-called focal dystonia. These are movement disorders that are caused in the brain and that lengthen and intensify over time until they result in immobile positions of the affected muscles. Eyelid cramps are involuntary contractions of the eye ring muscle (orbicularis oculi) that occur on both sides. This muscle is responsible for the closing of the eyelids and the reflex of the eyelid.

Differentiation: classic blepharospasm and eyelid inhibition type

A basic distinction is made between two forms of eyelid cramps. The classic blepharospasm is accompanied by clonic (rhythmic, relatively short) or tonic (evenly, relatively long-lasting) spasms of the circular muscle and it can also affect other muscles on the forehead and nose.

In addition, there is the rare and difficult-to-diagnose variant of the blepharospasm of the lid opening inhibition type. This expression is also known under the synonyms eyelid opening apraxia, as well as palpebral or pretarsal blepharospasm. Those affected have difficulty opening their eyes again after closing the eyelid. In contrast to the classic variant, this is not caused by contractions of the circular muscle, but by an inhibited activity of the levator palpebrae muscle. This muscle is responsible for lifting the upper eyelid. The frontal muscle is then used for compensation.

The two forms result in different wrinkles. The classic variant shows radial wrinkles around the eye, while the eyelid inhibition type creates horizontal forehead wrinkles. The disease is rare, with around three to four people affected among 100,000 people.

Symptoms

In general, the symptoms of those affected are very different. Both eyes are always affected by the uncontrollable eyelid cramps, whereby the expression can be different and the cramps can occur temporarily or permanently. The duration of the individual cramps is also very different, ranging from short contractions to long-lasting lid closures. If the latter is the case, the facial expressions and eyesight of those affected are severely impaired and functional blindness can even occur.

Often a first sign of the disease is a foreign body sensation in his eye, which is accompanied by an increased blinking. Mental stress and stress, as well as external factors such as bright light and wind, often intensify the symptoms. In most cases, the symptoms subside at night, but are more pronounced in the morning.

It is not uncommon for activities such as walking, climbing stairs, reading, driving a car or watching TV to make it more difficult and this results in functional visual impairment. On the other hand, if walking or speaking improves the symptoms, this is called paradoxical dystonia. But this happens very rarely.

If there is a blepharospasm for a longer period of time, this becomes visible through a pronounced wrinkling around the eyes - or less often on the forehead.

Causes

Blepharospasm is fundamentally one of the idiopathic diseases. These are independent clinical pictures, but the causes are mostly unknown. It is believed that the causes of eyelid cramps are in the central nervous system or in the basal ganglia (core areas in the brain). However, the exact mechanisms have not yet been researched. This is also referred to as the primary or essential blepharospasm.

In addition, the rarer (secondary) form of reflex or symptomatic blepharospasm is described. These are eyelid cramps, which are mostly triggered by irritating stimuli (for example, by a foreign body). Side effects of medication and various diseases can also be the cause of this form. These include irritation and inflammation of the eye (see also blepharitis), a dry eye (keratoconjunctivitis sicca) or systemic neurological diseases with spasms (e.g. Parkinson's).

Diagnosis

After a detailed patient survey (medical history) it is extremely important that other possible disorders of the eyelid opening and eyelid closure are excluded during the medical examination. Misdiagnoses are well known, such as "unilateral blepharospasm", which is usually a hemifacial spasm (unilateral facial muscle spasm) or a tic disorder (also called tick disorder). In this context, an involuntary, one-sided eye twitch occurs rather than an eyelid cramp.

It is not uncommon for a palpebral blepharospasm to be mistaken for a ptosis in ocular myasthenia, i.e. a sagging of the upper lid due to muscle weakness or muscle paralysis. These and other (eye) diseases must be ruled out when making a diagnosis and before any treatment. With the help of a slit lamp, for example, conjunctivitis or corneal inflammation can be determined, which can also be the cause of frequent blinking. Foreign bodies as the cause are usually found easily during a precise eye examination.

In addition, the blink frequency and a possible deviation from the normal values ​​are usually determined for a precise diagnosis. Electromyography (EMG) is used to measure muscle activity. Magnetic resonance imaging (MRI) can be helpful for further investigations into the possible causes of the nervous system.

Treatment

If the cause of a symptomatic blepharospasm is known, it is important to treat it. However, an essential blepharospasm cannot be permanently cured. The most common form of treatment, also with many other focal dystonias, is subcutaneous injection with botulinum toxin type A (botox). In the appropriate dosage, this shows the nerve agent of the bacterium Clostridium botulinum, due to the paralysis of the dark eye muscle, a successful effect. However, this is limited in time, which is why the treatment must be repeated every three months. About 90 percent of those treated report symptom relief. Possible side effects mostly affect the functions of the eyes and eyelids.

For those who do not respond to or refuse botulinum toxin therapy, surgical or medicinal measures can be further treatment options. Suspension operations, (partial) resection of the muscles in question or medicinal products that have, among other things, muscle-relaxing effects (for example benzodiazepines) are possible.

There are no preventive measures against blepharospasm. Sick people are advised to avoid stress, physical and psychological stress, strong sunlight and long television as much as possible. Sunglasses can also be worn to protect against glare.

Naturopathic treatment

Complementary measures from naturopathy can also relieve the symptoms in some cases. However, these alternative methods do not offer a chance of recovery either.

Especially in the early stages of the disease, stress reduction and (muscle) relaxation can help those affected. Various relaxation methods and other techniques are used in this context, such as autogenic training, yoga, meditation, acupuncture, hypnotherapy and biofeedback. Psychotherapy may also be considered. (tf, cs)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. rer. nat. Corinna Schultheis

Swell:

  • German Dystonia Society V .: Blepharospasm (accessed: July 8, 2019), dystonie.de
  • Merck & Co., Inc .: Blepharospasm (accessed: July 8, 2019), msdmanuals.com
  • Lang, Gerhard K .: Ophthalmology, Thieme, 6th edition, 2019
  • National Eye Institute (NEI): Facts About Blepharospasm (accessed: July 8, 2019), nei.nih.gov
  • American Academy of Family Physicians: Blepharospasm (accessed: July 8, 2019), familydoctor.org
  • American Association of Neuromuscular & Electrodiagnostic Medicine: Blepharospasm (accessed: July 8, 2019), aanem.org
  • Mayo Clinic: Eye twitching (accessed: July 8, 2019), mayoclinic.org
  • National Health Service UK: Twitching eyes and muscles (accessed: 08.07.2019), nhs.uk

ICD codes for this disease: G24ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


Video: Eye Twitches, Eye Spasms, Oh My! (October 2022).