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20-September-2008 10:08:29 - Blepharospasm Blepharospasm Classification and external resources Left orbicularis oculi, seen from behind. ICD-10 G24.5 ICD-9 333.81 DiseasesDB 15748 eMedicine oph/202 MeSH D001764 A blepharospasm from Greek: blepharo, eyelid, and spasm, an uncontrolled muscle contraction, is any abnormal tic or twitch of the eyelid. It normally refers to Benign Essential Blepharospasm, a focal dystonia - a neurological movement disorder involving involuntary and sustained muscle contractions of the muscles around the eyes. Benign means the condition is not life threatening. Essential indicates that the cause is unknown, but fatigue, stress, or an irritant are possible contributing factors. Symptoms sometimes last for a few days then disappear without treatment, but in most cases the twitching is chronic and persistent, causing lifelong challenges. The symptoms are often severe enough to result in functional blindness. The person's eyelids feel like they are clamping shut and will not open without great effort. Patients have normal eyes, but for periods of time are effectively blind due to their inability to open their eyelids. Although strides have recently been made in early diagnosis, blepharospasm is often initially mis-diagnosed as allergies or dry eye syndrome. It is a fairly rare disease, affecting only one in every 20,000 people in the United States. Contents 1 Symptoms 2 Causes 3 Treatment 4 External links Symptoms Excessive blinking and spasming of the eyes, usually characterized by uncontrollable eyelid closure of durations longer than the typical blink reflex, sometimes lasting minutes or even hours. Uncontrollable tics or twitches of the eye muscles and surrounding facial area. Some sufferers have twitching symptoms that radiate into the nose, face and sometimes, the neck area. Dryness of the eyes Sensitivity to the sun and bright light Causes What causes Blepharospasm is largely unknown, although some educated guesses are being made. In most cases, blepharospasm seems to develop spontaneously. Some blepharospasm patients have a history of dry eyes and/or light sensitivity, but others report no previous eye problems before onset of initial symptoms. Blepharospasm may also come from abnormal functioning of the brain's basal ganglia. Concomitance with dry eye, as well as other dystonias such as Meige's syndrome has been observed. Blepharospasms can be caused by concussions in some rare cases, when a blow to the back of the head damages the basal ganglia. Blepharospasm has furthermore been shown to appear alongside obsessive-compulsive symptoms, and the two are thought to share a physiological link. Some drugs can induce blepharospasm, such as those used to treat Parkinson's disease, as well as sensitivity to hormone treatments, including Estrogen replacement therapy for women going through Menopause; blepharospasm can also be a symptom of acute withdrawal from benzodiazepine dependence. Treatment Drug therapy: Drug therapy for blepharospasm has proved generally unpredictable and short-termed. Finding an effective regimen for any patient usually requires trial and error over time. In some cases a dietary supplement of magnesium chloride has been found effective. Botulin toxin Botox injections have been used, to induce localized, partial paralysis. Among most sufferers, botox is the preferred treatment method. Injections are generally administered every three months, with variations based on patient response and usually give almost immediate relief though for some it may take more than a week, from the spasming. Most patients can resume a relatively normal life with regular Botox treatments. A minority of sufferers get minimal or no result from Botox injections and have to find other treatments. For some, Botox diminishes in its effectiveness after many years of use. An observed side effect in a minority of patients is ptosis or eyelid droop. Attempts to inject in locations that minimise ptosis can result in diminished ability to control spasms. Surgery: Patients that do not respond well to medication or botulinum toxin injection are candidates for surgical therapy. The most effective surgical treatment has been protractor myectomy, the removal of muscles responsible for eyelid closure. Dark glasses are often worn because of sunlight sensitivity, as well as to hide the eyes from others. Stress management and support groups can help sufferers deal with the disease and prevent social isolation. External links Blepharospasm Resource Guide from the National Eye Institute NEI. BEBRF: Benign Essential Blepharospasm Research Foundation Comprehensive and up-to-date information about the disease, links to many informative articles on the subject, as well as support group contacts in most parts of the country. Blepharospasm, Steen-Hall Eye Institute v d e Pathology of the nervous system, primarily CNS G00-G47, 320-349 Inflammatory Meningitis Arachnoiditis - Encephalitis - Myelitis - Encephalomyelitis Acute disseminated - Tropical spastic paraparesis - Cavernous sinus thrombosis Systemic atrophies Huntington's disease - Spinocerebellar ataxia Friedreich's ataxia, Ataxia telangiectasia, Herary spastic paraplegia - Spinal muscular atrophy: Werdnig-Hoffman - Kugelberg-Welander - Fazio-Londe - MND ALS, PMA, PBP, PP, PLS Extrapyramidal and movement disorders Parkinson's disease - Neuroleptic malignant syndrome - Postencephalitic parkinsonism - Pantothenate kinase-associated neurodegeneration - Progressive supranuclear palsy - Striatonigral degeneration - Dystonia/Dyskinesia Spasmodic torticollis, Meige's, Blepharospasm - Essential tremor - Myoclonus - Lafora - Chorea Choreoathetosis - Restless legs - Stiff person Other degenerative/ demyelinating diseases dementia: Alzheimer's - Pick's - Dementia with Lewy bodies - Frontotemporal lobar degeneration mitochondrial disease: Leigh's demyelinating: Multiple sclerosis - Devic's - Central pontine myelinolysis - Transverse myelitis - Marchiafava-Bignami disease - CAMFAK syndrome - Alpers' Seizure/epilepsy Focal - Generalised - Status epilepticus - Myoclonic epilepsy Headache Migraine Familial hemiplegic - Cluster - Vascular - Tension Vascular Transient ischemic attack Amaurosis fugax, Transient global amnesia Cerebrovascular disease MCA, ACA, PCA, Foville's, Millard-Gubler, Lateral medullary, Weber's, Lacunar stroke Sleep disorders Insomnia - Hypersomnia - Sleep apnea Obstructive, Ondine's curse - Narcolepsy - Cataplexy - Kleine-Levin - Circadian rhythm sleep - Delayed sleep phase - Advanced sleep phase Intracranial hypertension Hydrocephalus Normal pressure - Idiopathic intracranial hypertension Other encephalopathy Brain herniation - Cerebral edema - Reye's Other spinal cord disease Syringomyelia - Syringobulbia - Morvan's syndrome - Spinal cord compression Retrieved from http://en..org/wiki/Blepharospasm Categories: Neurology Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Français Italiano Nederlands 日本語 РуÑ?Ñ?кий СрпÑ?ки / Srpski Suomi ä¸æ–‡ This page was last modified on 15 July 2008, at 19:48
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