(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (SR) Class of 2022, Baylor College of Medicine, Houston, Texas
Subject
Blepharospasm
Description
Summary: • Blepharospasm o Definition: benign spasm of the eyelids o Meige Syndrome: dystonia with blepharospasm that extends down the face o Dx: diagnosed clinically without the need for imaging o Tx: Botulinum toxin and rarely surgery (myectomy to strip out the muscles of the orbicularis)
Transcript
So today we're gonna be talking about blepharospasm, and it's exactly what the name implies. It's a spasm of your lids, the blephs like blepharitis. It's bilateral and simultaneous and it's spasm as opposed to weakness. If it extends down into your face we call that the Meige Syndrome and it's a dystonia. It's usually idiopathic and so we call it benign essential blepharospasm when it's the idiopathic variety. It's sometimes associated with other dystonias. Can be seen in Parkinson's disease and other patients who have dystonic motor dysfunction. The patients don't normally need to have an imaging study. There's usually no structural lesion. If it's isolated neurologically we don't have to scan it. The patients can be treated with Botox. So botulinum toxin injections will make the spasms stop. Different types and different preparations can be used. Medical therapy has been used in the past but it usually doesn't work very well. For patients who fail maximum dosing of botulinum toxin, there are surgical options where we can do a myectomy and strip out the muscles of the orbicularis, but this is kind of an extreme measure. It's usually easy to diagnose, but because it's intermittent, sometimes their patients don't have it at the time of the exam so I ask them to take a little video of it. It looks like this where they have bilateral spasm of the lids. It looks like they're closing their eyes really tight and it's benign. So you should know that benign essential blepharospasm is a bilateral simultaneous intermittent spasm of the lids. Sometimes it goes to the face. It's benign and we don't image it if it's isolated. Botulinum toxin injection is the treatment of choice and rarely patients have to have surgery.
