Blepharospasm

Classification according to ICD-10
G24.5	Blepharospasm
ICD-10 online (WHO version 2019)

With blepharospasm a spasmodic is called eyelid different causes and partly otherwise as a symptom of disease. It can occur unilaterally and bilaterally and should not be confused with ptosis .

Ocular blepharospasm

This type of spasmodic closure of the eyelids is caused by painful irritations, injuries, inflammations or foreign bodies on the eye.

Essential blepharospasm

The idiopathic form of eyelid spasm usually occurs on both sides and is based on an involuntary, repetitive increased innervation of the orbicularis oculi muscle with the lower eyelid slightly raised. It usually begins with excessive blinking , which is triggered in the early stages by bright light stimuli, tiredness and emotional tension . The symptoms increase in severity and severity over time and can be so severe that the eyes are completely closed for several hours. Its exact cause is unknown. It is believed that the brain's basal ganglia are malfunctioning , possibly due to an imbalance in the neurotransmitter dopamine . It can occur in connection with other convulsive changes ( grimacing ) of the facial, chewing or neck muscles and must be distinguished from similar symptoms in late dyskinesia , Parkinson's disease , Meige syndrome or caused by tetany , often in combination with so-called fish mouth ( protruding mouth).

Other forms

In addition to essential blepharospasm, a hemifacial spasm or facial myokymia must be considered, which have similar symptoms but different causes, such as vascular changes or nerve compression.

therapy

Surgical, drug and psychiatric treatments are usually unsuccessful. The therapy of choice is injections of the highly effective neurotoxin botulinum toxin , which is also used in the treatment of strabismus . With the appropriate dosage, they lead to paralysis of the orbicularis oculi muscle, reach their maximum effect after about 7 days and last for up to three months. The effectiveness of the treatment is stated in 96% of the patients.

literature

Albert J. Augustin: Ophthalmology . Springer, Berlin 2007, ISBN 978-3-540-30454-8 .
Rudolf Sachsenweger: Neuroophthalmology . 3. Edition. Thieme, Stuttgart 1983, ISBN 3-13-531003-5 .

Individual evidence

^ Herbert Kaufmann: Strabismus. 4th, fundamentally revised and expanded edition. with the collaboration of W. de Decker and others Georg Thieme Verlag, Stuttgart / New York 2012, ISBN 978-3-13-129724-2 .
^ Klaus Poeck : Neurology. 8th, revised and expanded edition. Springer, Berlin et al. 1992, ISBN 3-540-53810-0 , p. 285.
^ Albert J. Augustin: Ophthalmology . Springer Verlag, Berlin 2007, ISBN 978-3-540-30454-8 , p. 164.

[1] Herbert Kaufmann: Strabismus. 4th, fundamentally revised and expanded edition. with the collaboration of W. de Decker and others Georg Thieme Verlag, Stuttgart / New York 2012, ISBN 978-3-13-129724-2 .

[2] Klaus Poeck : Neurology. 8th, revised and expanded edition. Springer, Berlin et al. 1992, ISBN 3-540-53810-0 , p. 285.

[3] Albert J. Augustin: Ophthalmology . Springer Verlag, Berlin 2007, ISBN 978-3-540-30454-8 , p. 164.