Blepharospasm - eyelid cramp in the eye

Involuntary lid cramps

Blepharospasm (Lidkrampf) summarizes various forms of muscle cramps on the eyelid. For the most part, these are repeated, bilateral, spasmodic lid closures. The disease usually manifests itself initially by an increased blinking. In the further course it comes to recurrent and long-lasting eyelid cramps. Stress and other external factors can increase symptoms. The causes are still unclear and a permanent cure of the disease is not possible. The most common remedy for the treatment of blepharospasm is the neurotoxin botulinum toxin (Botox).

contents

• Involuntary lid cramps
• A short overview
• definition
• symptoms
• causes
• diagnosis
• treatment
• Naturopathic treatment

A short overview

The following overview briefly summarizes the following article on the clinical picture and possible treatment options for blepharospasm:

• definiton: Blepharospasm is a movement disorder caused in the brain, which leads to involuntary contractions of the eye ring muscle and thus to eyelid cramps.
• symptoms: The first sign of the disease is an increased blink, which later develops into uncontrollable and variable eyelid cramps, which may be temporary or permanent.
• causes: The causes are mostly unknown and are suspected in the central nervous system. Rarely, other illnesses, side effects of drugs or foreign bodies in the eye are the triggers.
• diagnosis: Accurate diagnosis and exclusion of other diseases requires, in addition to a thorough examination of the eyes, an assessment of Blinzel's frequency and muscle activity. Sometimes it is possible to investigate possible disorders in the nervous system to determine the cause.
• treatment: The drug of choice in most cases is botulinum toxin administered via subcutaneous injections at approximately three months intervals. Other treatments are less successful.
• Naturopathic treatment: Complementary stress reduction and muscle relaxation measures, such as acupuncture, meditation, or autogenic training, can help alleviate the symptoms.

The eyelid cramps caused by blepharospasm can severely affect those affected. (Image: Damir / fotolia.com)

definition

The term blepharospasm comes from the Greek and means freely translated Lidkrampf. Less common are the terms Blinzelkrampf and blepharism use for this disease. The blepharospasm is assigned to the so-called focal dystonia. These are movement disorders that are caused in the brain and that increase and increase over time until they result in immobile positions of the affected muscles. The eyelid cramps are bilateral, involuntary contractions of the eye ring muscle (orbicularis oculi muscle). This muscle is responsible for the eyelid closure and the eyelid reflex.

Distinction: Classical blepharospasm and eyelid-opening inhibition type

Basically, a distinction is made between two types of lid cramps. Classic blepharospasm involves clonic (rhythmic, relatively short) or tonic (even, relatively prolonged) spasms of the circular muscle and may affect other muscles on the forehead and nose.

In addition, the rare and difficult-to-diagnose variant of blepharospasm of the lid-opening inhibition type occurs. This expression is also known under the synonyms lid opening apraxia, as well as palpebral or pretarsal blepharospasm. In this case, those affected have difficulty reopening the eyes after eyelid closure. In contrast to the classical variant, this is not caused by contractions of the circular muscle but by an inhibited activity of the levator palpebrae muscle. This muscle is responsible for the elevation of the upper eyelid. To compensate for the frontal muscle (frontal muscle) is then used.

The two forms result in a different wrinkling. In the classical variant, radial folds show around the eye, in the eyelid-opening inhibition type horizontal forehead wrinkles form. The disease is rare, with about three to four people suffering from 100,000 people, rarely.

The rare eyelid-opening inhibition type of blepharospasm can be recognized by horizontal forehead wrinkles. (Image: donikz / fotolia.com)

symptoms

In general, the symptoms are very different for those affected. The uncontrollable eyelid cramps always affect both eyes, the severity can vary and the cramps can occur temporarily or permanently. The duration of the individual convulsions is also very different, ranging from short contractions to long-lasting eyelids. If the latter is the case, the facial expressions and the vision of those affected are severely impaired and functional blindness can even occur.

Often a first sign of the disease is a foreign body sensation to his eye, which is accompanied by increased blinking. Mental stress and stress, as well as external factors, such as bright light and wind, often increase the symptoms. In most cases, the symptoms subsided during the night, in the morning, however, they occur increasingly.

It is not uncommon for activities such as walking, climbing stairs, reading, driving or watching TV to be difficult, resulting in a functional visual impairment. If walking or speaking improves symptoms, it is called paradoxical dystonia. But this happens only very rarely.

If blepharospasm has been present for a long period of time, this becomes visible through pronounced wrinkling around the eyes - or, more rarely, on the forehead.

causes

Blepharospasm is a fundamental idiopathic disease. These represent independent clinical pictures in which the causes are mostly unknown. It is believed that the causes of eyelid cramps in the central nervous system, or in the basal ganglia (core areas in the brain), lie. The exact mechanisms have not yet been explored. This is also called primary or essential blepharospasm.

The unresearched causes of eyelid spasms are suspected in the basal ganglia of the central nervous system. (Image: Alex / fotolia.com)

In addition, the rarer (secondary) form of the reflex or symptomatic blepharospasm is described. These are lid cramps, which are usually triggered by irritating stimuli (for example, by a foreign body). For this form but also side effects of drugs and various diseases can be the cause. These include irritation and inflammation of the eye (see also blepharitis), a dry eye (keratoconjunctivitis sicca) or systemic neurological diseases with spasms (for example Parkinson's disease).

diagnosis

After a detailed patient survey (anamnesis), it is extremely important that the doctor excludes other possible disorders of eyelid opening and eyelid closure. Misdiagnoses are well known, such as "unilateral blepharospasm," which is usually hemifacial spasm (unilateral facial muscle spasm) or tic disorder (also tick disorder). In this context, however, an involuntary one-sided twitching appears rather than a lid spasm.

It is not uncommon for palpebral blepharospasm for ptosis to be associated with ocular myasthenia, ie, drooping of the upper lid due to muscle weakness or muscle paralysis. These and other (eye) diseases should be excluded at the time of diagnosis and prior to any treatment. With the help of a slit lamp, for example, conjunctivitis or corneal inflammation can be detected, which can also be the cause of frequent blinking. Even foreign bodies as a cause are usually found in the exact eye examination usually easy.

In addition, the blink frequency and a possible deviation from the normal values ​​are usually determined for a precise diagnosis. To measure muscle activity electromyography (EMG) is used. Magnetic Resonance Imaging (MRI) may be helpful in further investigation of possible causes in the nervous system.

The best therapy successes against the eye muscle cramps achieve repeated botulinum toxin injections. (Image: focusandblur / fotolia.com)

treatment

If the cause of symptomatic blepharospasm is known, it is important to treat it. An essential blepharospasm, however, can not be permanently cured. The most common form of treatment, even in many other focal dystonia, is subcutaneous injection with botulinum toxin type A (Botox). The neurotoxin of the bacterium is shown in the appropriate dosage Clostridium botulinum, by the paralysis of the eye ring muscle, a successful effect. However, this is limited in time, so the treatment must be repeated at intervals of about three months constantly. About 90 percent of those treated reported relief of symptoms. Possible side effects usually affect the functions of the eyes and eyelids.

For sufferers who do not respond to or refuse botulinum toxin therapy, surgical or medical treatment may be additional treatment options. In this case, suspension operations, (partial) resection of the muscles in question or drugs in question, which, inter alia, have a muscle relaxant effects (for example, benzodiazepines).

There are no preventive measures against blepharospasm. Patients are advised to avoid stress, physical and mental stress, strong sunlight and long television whenever possible. For protection against bright light, sunglasses can also be worn.

Relaxation techniques and other alternative methods can help alleviate the symptoms of blepharospasm. (Image: fizkes / fotolia.com)

Naturopathic treatment

Complementary measures from naturopathy can in some cases also bring about a relief of the symptoms. However, these alternatives do not offer any chance of recovery either.

Especially at the beginning of the disease, stress reduction and (muscle) relaxation can help those affected. Various relaxation methods and other techniques are used in this context, such as autogenic training, yoga, meditation, acupuncture, hypnotherapy and biofeedback. Psychotherapy may also be considered. (tf, cs; Updated on 27.09.2018)