Blepharospasm

Blepharospasm/Hemifacial Spasm/Apraxia of Eyelid Opening

Involuntary Eye blinking/ blepharospasm or hemifacial spasm

While eyelid twitching /eye spasm occasionally can occur in most people , it can become persistent, excessive, involuntary and adversely affect people’s lifestyle in which s/he may not be able to open his/ her eyes to see.   People describe it as uncontrolled eye blinking or uncontrolled eye movement, that is worsened when they are getting increasing anxious.  The condition is so severe that they are not able to cross the road and force to give up their career.

The cause of blepharospasm is usually unknown, hence it is usually name as essential blepharospasm.  Antidepressant and sedative were usually prescribed but with minimal effect.

The most effective treatment of blepharospasm  to date is administration of botulinum toxin (whether in form of botox, dysport or xeomin depending on preference of injector). It is a fast office procedure and is relatively painless.  Effect will be seen within a week and the duration can last for three to six months depending on individuals.  Side effect including ptosis (droopy eyelid) but it is unlikely in experienced hands).

Sometimes the involuntary twitching can affect one side of face (hemifacial spasm) especially corner of mouth (mouth or lip twitching).  This causes significant social embarrassment and self - consciousness. The cause are multifactorial, ranging from idiopathic (unknown cause) and tumour or vascular loop in brain compressing on facial nerve. It is often aggravated by dry eyes and emotional distress. MRI of brain is sometimes required to establish diagnosis of vascular loop around facial nerve.

Again, botulinum toxin proved to be an effective treatment.

The left side of this patient is twitching involuntarily.

The left side of this patient is twitching involuntarily.

TREATMENT

The treatment is usually botulinum toxin ( botox injection) onto affected muscle. Effects usually last for three months. However, Dr. Ho Shu Fen recently noted that coupling with addressing underlying issue ( emotional distress, incorrect posture) can help to achieve more sustainable remission and less Botox injection.

In the event of recalcitrant condition resistant to Botox treatment, surgery can be performed to treat the condition. If the cause of the condition is vascular loop compressing on the nerve, then surgical decompression.

Pre op:  This patient is not able to open both of his eyes.  He has multiple botox injection which has not been helping.

Pre op:  This patient is not able to open both of his eyes.  He has multiple botox injection which has not been helping.

Post op:  This patient has myomectomy (remove muscle which close his eyes) .  For the first time after many years, he is able to open his eyes and see well.

Post op:  This patient has myomectomy (remove muscle which close his eyes) .  For the first time after many years, he is able to open his eyes and see well.

 

Pre treatment:  Patient struggle to open both eyes despite effort.

 

Post treatment:  Patient can open both eyes widely and comfortably now.

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