1. BENIGN ESSENTIAL BLEPHAROSPASM (BEB)

Benign essential blepharospasm (BEB) is a neurological condition in which affected individuals experience involuntary muscle spasms and contractions of the muscles of the eyelids and around the eyes. Symptoms may begin as eye twitching and blinking and there may be symptoms of eye irritation. These spasms come and go in early stages of the disease. Eventually, BEB causes involuntary closure of the eyes.

The exact cause of BEB is unknown. Some evidence using functional neuroimaging suggests dysfunction within the basal ganglia.

BEB in most cases is isolated, but a positive family history may be seen in some patients with blepharospasm.

Periocular injections of botulinum toxin is regarded as the most effective treatment. Although, its effect is temporary lasting for 4-6 months, more than 95% of patients report significant improvement in there day- to – day life with these injections.

Although there is no oral medication that cures blepharospasm, drugs such as lorazepam, clonazepam and carbamazepine may be prescribed as adjunctive treatment.

Botulinum toxin commonly known as botox is injected accurately into the muscles around the eyes using a very fine gauge needle. We usually start with a dose of around 30-35 units which may be tailored to patient symptoms. It is a quick outpatient procedure and most patients experience little or no pain. It works by relaxing the muscles and thereby preventing the spasms. Maximal effect of treatment is seen between 3-7 days of injections and may last upto 4-6 months.

Accurate injections by an oculoplastic surgeon who is well versed with the anatomy of the eyes is usually safe and effective. Rarely side-effects due to spread of the drug to the adjacent muscles may occur and include drooping of the eyelid (ptosis) and double vision (diplopia) and dry eyes. All these are transient and recover spontaneously in 2-3 weeks time.

As the disease progresses in many patients, it is often necessary to increase the dose of the botulinum toxin. In some patients we may switch you from one type of botulinum toxin to another. Recent longterm studies have shown that in some patients with multiple treatments over a period of time, the effect of injection lasts longer and they require fewer injections per year. Surgery may be advised if the spasms worsen over the course of disease with shortened interval between injections.

A limited orbicularis myectomy of both the upper eyelid makes it easier for patients to open their eyes. In some patients a frontalis suspension with silicon rod may be required to keep the eyes open.

Surgery helps reduce the dose and frequency of botulinum injections, however very few patients can be actually completely weaned off the injections.

2. HEMIFACIAL SPASM

Hemifacial spasm (HFS) is a rare neuromuscular disease characterized by irregular, involuntary muscle contractions on one side of the face.

Hemifacial spasm is most often caused by a blood vessel pressing the facial nerve, but it may be caused by a facial nerve injury or a tumor, or it may not have a cause. Spasms occur in all the muscles that are supplied by this nerve on one side of the face. The facial nerve is primarily a motor nerve, meaning it controls muscles that move the eyebrows, close the eyes, and move the mouth and lips.

The diagnosis is clinical. This is a common condition that seen by an oculoplastic surgeon in the clinic. Before starting treatment, MRI brain scan is advised to look for any lesion such as a brain tumor, aneurysm, or AVM that may be causing facial nerve compression. The compression causes the nerve to misfire making your facial muscles contract.

Medication, surgery, and Botox injections are treatment options to stop the spasms and relieve the discomfort. Each treatment offers benefits, but each has limitations. You and your doctor should determine which treatment is best.

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