Q: My eyes are a big problem because of blepharospasms. I do not have control over opening them. Botox shots are the eye doctor’s idea and I have had a few series of them, but the last time that did not seem to make any difference and I do hate them. I hope you have some other solution to treat this horrible problem.
I very much enjoy your articles and look forward to an answer to my problem. I have not heard or seen about this in your column so please give me some advice.
A: Blepharospasm is an abnormal, involuntary blinking or spasm of the eyelids that results from the closure of the eyelids. It may begin gradually with excessive blinking and/or eye irritation that may disappear during periods of sleeping. Some individuals may find that following a good night’s sleep the spasms diminish for several hours after waking. As the disorder progresses, the spasms may intensify to the stage that the individual is functionally blind and the eyelids remain closed for hours at a time. Specific known triggers including emotional tension, fatigue and bright lights in the early stages. It is estimated that there at least 50,000 cases of blepharospasm in the United States, with up to 2,000 new cases diagnosed annually. The prevalence of blepharospasm in the general population is approximately 5 in 100,000. This and other dystonic disorders may have a correlation with tremor, restless legs syndrome, bruxism, or a family history of tremor or dystonia (the involuntary contraction of muscles that cause uncontrollable twisting or repetitive movements of a specific body part. .
Symptoms vary in intensity, from being minimally disturbing to being completely disabling. Because the condition can be severe, individuals find they cannot read, watch television, drive a car, or engage in countless other activities. As a result, depression and anxiety may set in and may have to be addressed with a professional.
The condition is thought to be due to an abnormal function of the basal ganglia (located at the base of the brain) on occasion. Interestingly, symptoms of dry eye often precede or occur concomitantly with blepharospasm. Thus, it has been suggested that dry eye may trigger an onset in susceptible individuals. It can occur with dystonia, affecting the mouth and/or jaw. There may also be a correlation with drugs such as those used to treat Parkinson’s disease. If this connection is made, a reduction of dosing generally alleviates the problem.
There is no complete cure for blepharospasm. The therapy of choice is non-surgical botulinum neurotoxin (BOTOX) injections that reduce symptoms for many individuals. These injections were approved by the FDA in 1989 for blepharospasm. For those who fail to experience a successful reduction of symptoms, oral medications might be offered, followed by surgery known as protractor myectomy. This procedure removes some or all of the muscles responsible for the eyelids to close and has been found effective for improving visual disabilities in up to 80% of all cases. It should be noted that before any surgical procedure is recommended, patients are often advised to consider BOTOX.
I recommend you have a frank talk with your ophthalmologist or other specialist who is handling your case. Express your concerns and work together to determine which method of treatment might be best for you. If your latest BOTOX failed to reveal progress, perhaps it is time to move on to oral medication or even surgery. I cannot answer that critical question for you but support groups are available across the country. You might choose to join one near your home. By doing this, you can speak with individuals who may have had to make the same critical choice you are facing. It might help to get someone else’s perspective so you can be guided toward making an appropriate decision.
