Blepharospasm (an abnormal contraction of the eyelid muscles)

                                                                      Blepharospasm

        (an abnormal contraction of the eyelid muscles)

     Blepharospasm is an abnormal contraction of the eyelids muscles. It often refers to benign essential blepharospasm(BEB) which is a bilateral condition and a form of focal dystonia leading to episodic closure of the eyelids. The exact cause of blepharospasm is unknown and, by definition, it is not associated with another disease entity or syndrome. 

   Symptoms usually begin as mild and infrequent spasm that progress over time to forceful and frequent contractures of the eyelids. In advanced cases causing functional blindness form inability to temporarily open the eyes. It often refers to benign essential blepharospasm which is a bilateral condition and a form of focal dystonia leading to episodic closure of the eyelids.

Pathophysiology: 

 The mechanism underlying benign essential blepharospasm is not clear. Basal ganglia dysfunction, overactivity of the seventh nerve leading to simultaneous forceful contractions of the eyelid protractors and retractors, ion channelopathy, and sensitization of the trigeminal system by photophobia are some of the proposed mechanisms. 

Causes: 

Stress: Is the body's reaction to any change that requires an adjustment or response. The body reacts to these changes with physical, mental, and emotional responses. Stress is a normal part of life. You can experience stress from your environment, your body, and your thoughts. 

Fatigue: Term used to describe an overall feeling of tiredness or lack of energy. It isn't the same as simply feeling drowsy or sleepy. When you're fatigued, you have no motivation and no energy. Being sleepy may be a symptom of fatigue. 

Dry eyes: Common conditions that occur when your tears aren't able to provide adequate lubrication for your eyes. Tears can be inadequate for many reasons. 

Eye strain: This occurs when your eyes get tired from intense use, such as driving a car for extended periods, reading, or working at the computer. If you have any eye discomfort caused by looking at something for a long time, you can call it eye strain. 

Pink eye(conjunctivitis): This is an inflammation or infection of the transparent membrane that lines your eyelid and covers the white part of your eyeball. When small blood vessels in the conjunctiva become inflamed, they're more visible. This is what causes the whites of your eyes to appear reddish or pink. 

Common causes:

 Eye twitching can have causes that aren't due to underlying disease. Examples include muscle twitches, fatigue, sleep deprivation prolonged screen time. 

Others risk factors:

 Variable risk factors for blepharospasm have been reported: 

- Head or facial trauma

- Family history of dystonia or tremor

- Reflex blepharospasm is reportedly triggered by several dry eyes and blepharitis, intraocular inflammation, meningeal irritation, light sensitivity. 

- Stress may exacerbate benign essential blepharospasm

- Medications, such as those used to treat Parkinson's biases have been associated with blepharospasm. 

Signs and symptoms: 

  - A gradual increase in blinking or eye irritation

- Fatigue

- Emotional tension

- Sensitive to bright light

- Facial spasms

- Blurred vision

- Headache 

Diagnosis:

 - Diagnosis of benign essential blepharospasm in clinically and it is a diagnosis of exclusion, having ruled out the presence of associated conditions. The diagnosis of blepharospasm is clinical and is made by careful history taking and physical exam. 

Complication:

 - Complications associated with

- Bruising

- Blepharoptosis

- ectropion

- Epiphora, diplopia

- Lagophthalmos and corneal exposure

Prognosis:

 90% improve symptomatically with injections, although continued injections are necessary. Patients with apraxia opening often do not respond as well to injections. 

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