Blepharospasm: Difference between revisions

Blepharospasm
Blepharospasm
Other names	Eye dystonia, Eye twitching, Eye spasm
Pronunciation	/ˌblɛfəroʊˈspæzəm/ ;
Specialty	Neurology, ophthalmology

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Blepharospasm is a neurological disorder characterized by intermittent, involuntary spasms and contractions of the orbicularis oculi (eyelid) muscles around both eyes.^[1]^[2]^[3]^[4] These result in abnormal twitching or blinking, and in the extreme, sustained eyelid closure resulting in functional blindness.

The word blepharospasm is derived from the Greek: βλέφαρον / blepharon, eyelid, and σπασμός / spasmos, spasm, an uncontrolled muscle contraction. The condition should be distinguished from the more common, and milder, involuntary quivering of an eyelid, known as myokymia or fasciculation.

Blepharospasm is one form of a group of movement disorders called dystonia.^[4] It may be a primary or secondary disorder. The primary disorder is benign essential blepharospasm, in which term the qualifier essential indicates that the cause is unknown. Blepharospasm may occur as secondary to conditions including dry eyes and other specific ocular disease or conditions, Meige's Syndrome and other forms of dystonia, and Parkinson's Disease and other movement disorders.^[3]

Blepharospasm occurs in middle age and is more frequent among women than men. The most common treatments are medication and periodic injections of botulinum toxin into the eyelid muscles.

Epidemiology

Blepharospasm is a fairly rare disease. Estimates of incidence and prevalence vary, tending to be higher in population studies than service studies,^[5] likely because of delays in diagnosis.^[4] In the United States, approximately 2,000 new cases of blepharospasm are diagnosed each year.^[6] Estimates of incidence per million persons-years range from 14.5 in Northern California^[7] to 100 in Taiwan.^[8] Estimates of prevalence per million range from 12 in Olmsted County, Minnesota^[9] to 133 in Puglia, Southern Italy.^[10]

The onset of blepharospasm tends to be during the ages 40-60.^[8]^[10]^[11] The condition is roughly more than twice as frequent among females than males,^[7]^[8]^[11] which may be related to menopause and hormone treatments.^[12]^[13] In Taiwan, the condition is more frequent among white- than blue-collar workers.^[8]

Signs and symptoms

Blepharospasm usually begins with occasional twitches of both eyelids, which progress over time to forceful and frequent spasms and contractions of the eyelids. In severe episodes, the patient cannot open their eyelids (apraxia), which severely limits their daily activities. Prolonged closure of the eyelids may result in functional blindness.^[4]

Patients suffering from blepharospasm also report sensory symptoms including sensitivity to light,^[14]^[15] dry eyes,^[16] and burning sensation and grittiness in the eyes.^[4] Although such symptoms tend to precede the onset of the blepharospasm, they may both be due to a common third factor.^[17]

Typically, the symptoms---spasms and contractions of the eyelids---tend to worsen when the patient relaxes but abate during sleep.^[18] The symptoms may be temporarily alleviated by sensory tricks (geste antagoniste) including stretching or rubbing the eyebrows, eyelids, or forehead,^[19] and singing, talking, or humming.^[20] Blepharospasm is aggravated by fatigue, stress, and environmental factors such as wind or air pollution.^[21]

Although blepharospasm is defined as a bilaterally symmetric disorder that affects both eyes, some research has reported unilateral onset.^[11]^[22]

Causes

Historically, it was believed that blepharospasm was due to the abnormal functioning of the brain's basal ganglia.^[23] The basal ganglia are structures in the brain that are involved in the regulation of motor and reward functions.

However, blepharospasm is now known to involve several regions of the brain and to be a multifactorial condition in which "one or several as yet unknown genes together with epigenetic and environmental factors combine to reach the threshold that induces the disease".^[3]

Blepharospasm is often associated with dry eyes, but the causal mechanism is still not clear.^[16]^[8] Research in New York and Italy suggests that increased blinking (which may be triggered by dry eyes) leads to blepharospasm.^[24]^[25] A case control study in China found that blepharospasm aggravated dry eyes.^[26]

Blepharospasm may be associated with dystonia in other parts of the body, particularly Meige's Syndrome.^[27]^[28]^[4] Blepharospasm may be associated with Parkinson's Disease, but the causal mechanism is still not clear.^[29]^[30] In rare cases, blepharospasm is associated with multiple sclerosis.^[31]^[32]

Some drugs can induce blepharospasm, including those used to treat depression^[33]^[34] and Parkinson's disease.^[35] Hormone replacement therapy for women going through menopause has been found to be associated with dry eyes,^[13] which in turn is associated with blepharospasm.

Blepharospasm can be caused by concussions in some rare cases, when a blow to the back of the head damages the basal ganglia.^[36]

Blepharospasm is associated with exposure to the sun.^[37]

Diagnosis

No laboratory tests exist with which to definitively diagnose blepharospasm. Historically, the condition was frequently misdiagnosed,^[18] often as a psychiatric condition.^[6]

Diagnosis of blepharospasm has been enhanced by the proposal of objective diagnostic criteria that start from "stereotyped, bilateral and synchronous orbicularis oculi spasms" and proceed to the identification of a "sensory trick" or "increased blinking".^[38] The criteria have been validated across multiple ethnicities in multiple centers.^[39]

Treatment

Standard first line treatments of blepharospasm are conservative therapies, oral medication, and periodic injections of botulinum toxin.

Particularly when associated with dry eyes, blepharospasm may be relieved with warm compresses, eye drops, and eye wipes.^[40]^[41] A Japanese study showed that warm compresses containing menthol were more effective in increasing tear film.^[42]

Drugs used to treat blepharospasm are anticholinergics, benzodiazepines, baclofen, and tetrabenazine.^[43] The proportion of patients who benefited from anticholinergics ranged from 1 in 9 in Oregon^[44] to 1 in 5 in England.^[11] Besides failing to resolve the blepharospasm, some drugs present the risk of side effects. In Japan, use of etizolam and benzodiazepine was associated with the development of blepharospasm.^[33]^[34] A case report from Sri Lanka suggests treatment with Mosapride.^[45]

The main first-line therapy is periodic injections of botulinum toxin type A to induce localized, partial paralysis of the eyelid muscles.^[46]^[47] Injections are generally administered at intervals of around 10 weeks, with variations based on patient response and usually give fairly quick relief from the muscle spasms. An English study reported that 118 (78%) of 151 patients experienced significant relief of symptoms for a mean duration of 9.2 weeks.^[11] However, in a minority of patients, the injections do not provide any symptomatic relief. Injections of botulinum toxin may diminish in effectiveness with prolonged use and require increased dosage.^[48] Injections of botulinum toxin increase the risk of visual complaints and ptosis (eyelid droop).^[46]

Patients who do not respond well to medication or botulinum toxin injections are candidates for surgical therapy. The most effective surgical treatment has been protractor myectomy, the removal of muscles responsible for eyelid closure.^[49] Myectomy is more effective than distal neurectomy.^[50]

A case report from California suggests the use of intense pulsed light therapy to relieve blepharospasm.^[51] Several complementary therapies simulate sensory tricks. One is to attach a device to spectacle frames to press on the patient's temple.^[52] Another is the application of thin cosmetic tapes to the forehead and eyebrows.^[53]

Another complementary therapy is retraining the brain to "rewire" itself and eliminate dystonic movements. Associated with Joaquin Farias, sensorimotor retraining activities and proprioceptive stimulation aim to induce neuroplasticity, making it possible for patients to recover substantial function that was lost due to blepharospasm.^[54]^[55]

Patients suffering from blepharospasm may get relief by wearing spectacles fitted to lift the upper eyelid.^[43]

Forschung

The U.S. National Library of Medicine maintains a register of clinical trials of therapies to treat blepharospasm.

Multimedia

Blepharospasm Research Foundation

Victoria S. Pelak, Relationships of Blepharospasm to Ophthalmic Conditions such as Dry Eye, BEBRF Symposium, August 6, 2016.
Charles N.S. Soparkar, Blepharospasm and dry eyes, BEBRF Symposium, September 9, 2017.
Complementary/alternative therapies, Philadelphia, October 9, 2021

Neuroplasticity training

Federico Bitti, "Dystonia. Rewiring the brain through movement and dance", TEDxNapoli
Joaquin Farias, "How your movements can heal your brain", TEDxNapoli

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^ Fantato, Alexina; Parulekar, Manoj; Elston, John (2 July 2019). "A trial of a mechanical device for the treatment of blepharospasm". Eye. 33 (11): 1803–1808. doi:10.1038/s41433-019-0495-y. ISSN 0950-222X. PMC 7002569. PMID 31267089.
^ Uchida, Kazuko; Kiyosawa, Motohiro; Wakakura, Masato (2020). "Efficacy of a Non-invasive Cosmetic Forcible Trick Treatment for Blepharospasm: Increase in Quality of Life Due to Use of Ultra-thin Adhesive Tape". NeuroOphthalmology Japan. 37 (2): 237–243. doi:10.11476/shinkeiganka.37.237 – via JStage.
^ Farias, Joaquin (2016). Limitless. How your movements can heal your brain: An essay on the neurodynamics of dystonia. Galene Editions. ISBN 978-0-9951701-0-0.
^ Farias, J., Sarti-Martínez, MA. Title: "Elite musicians treated by specific fingers motion program to stimulate propiceptive sense", Congreso Nacional De La Sociedad Anatómica Española, Alicante (España), European Journal of Anatomy, p. 110

External links

[1] Hallett, Mark (12 November 2002). "Blepharospasm: Recent advances". Neurology. 59 (9): 1306–1312. doi:10.1212/01.WNL.0000027361.73814.0E. ISSN 0028-3878. PMID 12434791.

[2] Hallett, Mark; Evinger, Craig; Jankovic, Joseph; Stacy, Mark (14 October 2008). "Update on blepharospasm". Neurology. 71 (16): 1275–1282. doi:10.1212/01.wnl.0000327601.46315.85. ISSN 0028-3878. PMC 2676990. PMID 18852443.

[:8-3] Defazio, Giovanni; Hallett, Mark; Jinnah, Hyder A.; Conte, Antonella; Berardelli, Alfredo (10 February 2017). "Blepharospasm 40 years later". Movement Disorders. 32 (4): 498–509. doi:10.1002/mds.26934. ISSN 0885-3185. PMC 5941939. PMID 28186662.

[:4-4] ^ ^a ^b ^c ^d ^e ^f Scorr, Laura M.; Cho, Hyun Joo; Kilic-Berkmen, Gamze; McKay, J. Lucas; Hallett, Mark; Klein, Christine; Baumer, Tobias; Berman, Brian D.; Feuerstein, Jeanne S.; Perlmutter, Joel S.; Berardelli, Alfredo; Ferrazzano, Gina; Wagle-Shukla, Aparna; Malaty, Irene A.; Jankovic, Joseph (16 May 2022). "Clinical Features and Evolution of Blepharospasm: A Multicenter International Cohort and Systematic Literature Review". Dystonia. 1. doi:10.3389/dyst.2022.10359. ISSN 2813-2106. PMC 9557246. PMID 36248010.

[5] Steeves, Thomas D.; Day, Lundy; Dykeman, Jonathan; Jette, Nathalie; Pringsheim, Tamara (31 October 2012). "The prevalence of primary dystonia: A systematic review and meta-analysis". Movement Disorders. 27 (14): 1789–1796. doi:10.1002/mds.25244. ISSN 0885-3185. PMID 23114997.

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[:2-7] Byrd, Erica; Albers, Kathleen; Goldman, Samuel; Klingman, Jeffrey; Lo, Raymond; Marras, Connie; Leimpeter, Amethyst; Fross, Robin; Comyns, Kathleen; Gu, Zhuqin; Katz, Maya; Ozelius, Laurie; Bressman, Susan; Saunders-Pullman, Rachel; Comella, Cynthia (5 April 2016). "Blepharospasm in a Multiethnic Population (P3.348)". Neurology. 86 (16_supplement). doi:10.1212/wnl.86.16_supplement.p3.348. ISSN 0028-3878.

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@@ Line 1: / Line 1: @@
 {{short description|Abnormal contraction or twitch of the eyelid}}
-{{refimprove|date=February 2020}}
 {{Infobox medical condition (new)
 | name            = Blepharospasm
@@ Line 13: / Line 12: @@
 }}
 <!-- Definition and symptoms -->
-'''Blepharospasm''' is a neurological disorder characterized by intermittent, involuntary spasms and contractions of the [[orbicularis oculi muscle|orbicularis oculi (eyelid) muscles]] around both eyes.<ref>{{Cite journal |last1=Defazio |first1=Giovanni |last2=Hallett |first2=Mark |last3=Jinnah |first3=Hyder A. |last4=Conte |first4=Antonella |last5=Berardelli |first5=Alfredo |date=2017-02-10 |title=Blepharospasm 40 years later |url=http://dx.doi.org/10.1002/mds.26934 |journal=Movement Disorders |volume=32 |issue=4 |pages=498–509 |doi=10.1002/mds.26934 |pmid=28186662 |pmc=5941939 |issn=0885-3185}}</ref><ref name=":4">{{Cite journal |last1=Scorr |first1=Laura M. |last2=Cho |first2=Hyun Joo |last3=Kilic-Berkmen |first3=Gamze |last4=McKay |first4=J. Lucas |last5=Hallett |first5=Mark |last6=Klein |first6=Christine |last7=Baumer |first7=Tobias |last8=Berman |first8=Brian D. |last9=Feuerstein |first9=Jeanne S. |last10=Perlmutter |first10=Joel S. |last11=Berardelli |first11=Alfredo |last12=Ferrazzano |first12=Gina |last13=Wagle-Shukla |first13=Aparna |last14=Malaty |first14=Irene A. |last15=Jankovic |first15=Joseph |date=2022-05-16 |title=Clinical Features and Evolution of Blepharospasm: A Multicenter International Cohort and Systematic Literature Review |journal=Dystonia |volume=1 |doi=10.3389/dyst.2022.10359 |doi-access=free |pmid=36248010 |issn=2813-2106}}</ref>  These result in abnormal twitching or blinking, and in the extreme, closure of the eyes.
+'''Blepharospasm''' is a neurological disorder characterized by intermittent, involuntary spasms and contractions of the [[orbicularis oculi muscle|orbicularis oculi (eyelid) muscles]] around both eyes.<ref>{{Cite journal |last=Hallett |first=Mark |date=2002-11-12 |title=Blepharospasm: Recent advances |url=https://www.neurology.org/doi/10.1212/01.WNL.0000027361.73814.0E |journal=Neurology |language=en |volume=59 |issue=9 |pages=1306–1312 |doi=10.1212/01.WNL.0000027361.73814.0E |pmid=12434791 |issn=0028-3878}}</ref><ref>{{Cite journal |last1=Hallett |first1=Mark |last2=Evinger |first2=Craig |last3=Jankovic |first3=Joseph |last4=Stacy |first4=Mark |date=2008-10-14 |title=Update on blepharospasm |url=http://dx.doi.org/10.1212/01.wnl.0000327601.46315.85 |journal=Neurology |volume=71 |issue=16 |pages=1275–1282 |doi=10.1212/01.wnl.0000327601.46315.85 |pmid=18852443 |issn=0028-3878|pmc=2676990 }}</ref><ref name=":8">{{Cite journal |last1=Defazio |first1=Giovanni |last2=Hallett |first2=Mark |last3=Jinnah |first3=Hyder A. |last4=Conte |first4=Antonella |last5=Berardelli |first5=Alfredo |date=2017-02-10 |title=Blepharospasm 40 years later |url=http://dx.doi.org/10.1002/mds.26934 |journal=Movement Disorders |volume=32 |issue=4 |pages=498–509 |doi=10.1002/mds.26934 |pmid=28186662 |pmc=5941939 |issn=0885-3185}}</ref><ref name=":4">{{Cite journal |last1=Scorr |first1=Laura M. |last2=Cho |first2=Hyun Joo |last3=Kilic-Berkmen |first3=Gamze |last4=McKay |first4=J. Lucas |last5=Hallett |first5=Mark |last6=Klein |first6=Christine |last7=Baumer |first7=Tobias |last8=Berman |first8=Brian D. |last9=Feuerstein |first9=Jeanne S. |last10=Perlmutter |first10=Joel S. |last11=Berardelli |first11=Alfredo |last12=Ferrazzano |first12=Gina |last13=Wagle-Shukla |first13=Aparna |last14=Malaty |first14=Irene A. |last15=Jankovic |first15=Joseph |date=2022-05-16 |title=Clinical Features and Evolution of Blepharospasm: A Multicenter International Cohort and Systematic Literature Review |journal=Dystonia |volume=1 |doi=10.3389/dyst.2022.10359 |doi-access=free |pmid=36248010 |issn=2813-2106|pmc=9557246 }}</ref>  These result in abnormal twitching or blinking, and in the extreme, sustained eyelid closure resulting in functional blindness.
 The word blepharospasm is derived from the Greek: βλέφαρον / blepharon, eyelid, and σπασμός / spasmos, ''[[spasm]],'' an uncontrolled muscle contraction. The condition should be distinguished from the more common, and milder, involuntary quivering of an eyelid, known as [[myokymia]] or [[fasciculation]].
-Blepharospasm is one form of a group of movement disorders called [[dystonia]].<ref name=":4" />  It may be a primary or secondary disorder. The primary disorder is benign essential blepharospasm, in which term the qualifier ''essential'' indicates that the [[Idiopathic|cause is unknown]]. Blepharospasm as a secondary disorder is caused by a disorder of the orofacial muscles, [https://rarediseases.org/rare-diseases/meige-syndrome/ Meige's Syndrome], or specific ocular disease or condition, such as [https://eyewiki.aao.org/Exposure_Keratopathy keratopy] and [https://eyewiki.aao.org/Ocular_Discomfort irritation].
+Blepharospasm is one form of a group of movement disorders called [[dystonia]].<ref name=":4" />  It may be a primary or secondary disorder. The primary disorder is benign essential blepharospasm, in which term the qualifier ''essential'' indicates that the [[Idiopathic|cause is unknown]]. Blepharospasm may occur as secondary to conditions including dry eyes and other specific ocular disease or conditions, [[Meige's syndrome|Meige's Syndrome]] and other forms of dystonia, and [[Parkinson's disease|Parkinson's Disease]] and other movement disorders.<ref name=":8" />
-Blepharospasm occurs in middle age and is more frequent among women than men. The most common first line treatments are medication and injections of botulinum toxin into the eyelid protractor muscles.
+Blepharospasm occurs in middle age and is more frequent among women than men. The most common treatments are medication and periodic injections of botulinum toxin into the eyelid muscles.
 == Epidemiology ==
 Blepharospasm is a fairly rare disease. Estimates of incidence and prevalence vary, tending to be higher in population studies than service studies,<ref>{{Cite journal |last1=Steeves |first1=Thomas D. |last2=Day |first2=Lundy |last3=Dykeman |first3=Jonathan |last4=Jette |first4=Nathalie |last5=Pringsheim |first5=Tamara |date=2012-10-31 |title=The prevalence of primary dystonia: A systematic review and meta-analysis |url=http://dx.doi.org/10.1002/mds.25244 |journal=Movement Disorders |volume=27 |issue=14 |pages=1789–1796 |doi=10.1002/mds.25244 |pmid=23114997 |issn=0885-3185}}</ref> likely because of delays in diagnosis.<ref name=":4" /> In the United States, approximately 2,000 new cases of blepharospasm are diagnosed each year.<ref name=":0">{{Cite journal |last1=Simon |first1=Guy J. Ben |last2=McCann |first2=John D. |date=Summer 2005 |title=Benign Essential Blepharospasm |url=https://journals.lww.com/internat-ophthalmology/citation/2005/04530/benign_essential_blepharospasm.7.aspx |journal=International Ophthalmology Clinics |language=en-US |volume=45 |issue=3 |pages=49–75 |doi=10.1097/01.iio.0000167238.26526.a8 |pmid=15970766 |issn=0020-8167}}</ref> Estimates of incidence per million persons-years range from 14.5 in Northern California<ref name=":2">{{Cite journal |last1=Byrd |first1=Erica |last2=Albers |first2=Kathleen |last3=Goldman |first3=Samuel |last4=Klingman |first4=Jeffrey |last5=Lo |first5=Raymond |last6=Marras |first6=Connie |last7=Leimpeter |first7=Amethyst |last8=Fross |first8=Robin |last9=Comyns |first9=Kathleen |last10=Gu |first10=Zhuqin |last11=Katz |first11=Maya |last12=Ozelius |first12=Laurie |last13=Bressman |first13=Susan |last14=Saunders-Pullman |first14=Rachel |last15=Comella |first15=Cynthia |date=2016-04-05 |title=Blepharospasm in a Multiethnic Population (P3.348) |url=http://dx.doi.org/10.1212/wnl.86.16_supplement.p3.348 |journal=Neurology |volume=86 |issue=16_supplement |doi=10.1212/wnl.86.16_supplement.p3.348 |issn=0028-3878}}</ref> to 100 in Taiwan.<ref name=":1">{{Cite journal |last1=Sun |first1=Yng |last2=Tsai |first2=Pei-Jhen |last3=Chu |first3=Chin-Liang |last4=Huang |first4=Wei-Chun |last5=Bee |first5=Youn-Shen |date=2018-12-26 |title=Epidemiology of benign essential blepharospasm: A nationwide population-based retrospective study in Taiwan |journal=PLOS ONE |language=en |volume=13 |issue=12 |pages=e0209558 |doi=10.1371/journal.pone.0209558 |doi-access=free |issn=1932-6203 |pmc=6306223 |pmid=30586395|bibcode=2018PLoSO..1309558S }}</ref> Estimates of prevalence per million range from 12 in Olmsted County, Minnesota<ref>{{Cite journal |last1=Bradley |first1=Elizabeth A. |last2=Hodge |first2=David O. |last3=Bartley |first3=George B. |date=May 2003 |title=Benign Essential Blepharospasm Among Residents of Olmsted County, Minnesota, 1976 to 1995: An Epidemiologic Study |url=https://journals.lww.com/op-rs/abstract/2003/05000/benign_essential_blepharospasm_among_residents_of.2.aspx |journal=Ophthalmic Plastic & Reconstructive Surgery |language=en-US |volume=19 |issue=3 |pages=177–181 |doi=10.1097/01.IOP.0000065203.88182.CF |pmid=12918550 |issn=0740-9303}}</ref> to 133 in Puglia, Southern Italy.<ref name=":3">{{Cite journal |last1=Defazio |first1=G. |last2=Livrea |first2=P. |last3=De Salvia |first3=R. |last4=Manobianca |first4=G. |last5=Coviello |first5=V. |last6=Anaclerio |first6=D. |last7=Guerra |first7=V. |last8=Martino |first8=D. |last9=Valluzzi |first9=F. |last10=Liguori |first10=R. |last11=Logroscino |first11=G. |date=2001-06-12 |title=Prevalence of primary blepharospasm in a community of Puglia region, Southern Italy |url=http://dx.doi.org/10.1212/wnl.56.11.1579 |journal=Neurology |volume=56 |issue=11 |pages=1579–1581 |doi=10.1212/wnl.56.11.1579 |pmid=11402121 |issn=0028-3878}}</ref>
-The onset of blepharospasm tends to be during the ages 40-60.<ref name=":1" /><ref name=":3" /> The condition is twice or more frequent among females than males,<ref name=":2" /><ref name=":1" /> which may be related to menopause.<ref>{{Cite journal |last1=Martino |first1=Davide |last2=Livrea |first2=Paolo |last3=Giorelli |first3=Maurizio |last4=Masi |first4=Gianluca |last5=Aniello |first5=Maria Stella |last6=Defazio |first6=Giovanni |date=2002 |title=Menopause and Menarche in Patients with Primary Blepharospasm: An Exploratory Case-Control Study |url=http://dx.doi.org/10.1159/000047975 |journal=European Neurology |volume=47 |issue=3 |pages=161–164 |doi=10.1159/000047975 |pmid=11914554 |issn=0014-3022}}</ref> In Taiwan, the condition was found to be more frequent among white-collar workers.<ref name=":1" />
+The onset of blepharospasm tends to be during the ages 40-60.<ref name=":1" /><ref name=":3" /><ref name=":10" /> The condition is roughly more than twice as frequent among females than males,<ref name=":2" /><ref name=":1" /><ref name=":10" /> which may be related to menopause and hormone treatments.<ref>{{Cite journal |last1=Martino |first1=Davide |last2=Livrea |first2=Paolo |last3=Giorelli |first3=Maurizio |last4=Masi |first4=Gianluca |last5=Aniello |first5=Maria Stella |last6=Defazio |first6=Giovanni |date=2002 |title=Menopause and Menarche in Patients with Primary Blepharospasm: An Exploratory Case-Control Study |url=http://dx.doi.org/10.1159/000047975 |journal=European Neurology |volume=47 |issue=3 |pages=161–164 |doi=10.1159/000047975 |pmid=11914554 |issn=0014-3022}}</ref><ref name=":9" /> In Taiwan, the condition is more frequent among white- than blue-collar workers.<ref name=":1" />
 ==Signs and symptoms==
 Blepharospasm usually begins with occasional twitches of both eyelids, which progress over time to forceful and frequent spasms and contractions of the eyelids. In severe episodes, the patient cannot open their eyelids (apraxia), which severely limits their daily activities. Prolonged closure of the eyelids may result in functional blindness.<ref name=":4" />
-Patients suffering from blepharospasm also report sensory symptoms including sensitivity to light,<ref>{{cite journal |vauthors=Adams WH, Digre KB, Patel BC, Anderson RL, Warner JE, Katz BJ |date=July 2006 |title=The evaluation of light sensitivity in benign essential blepharospasm |journal=American Journal of Ophthalmology |volume=142 |issue=1 |pages=82–87 |doi=10.1016/j.ajo.2006.02.020 |pmid=16815254}}</ref><ref>{{Cite journal |last1=Molloy |first1=Anna |last2=Williams |first2=Laura |last3=Kimmich |first3=Okka |last4=Butler |first4=John S |last5=Beiser |first5=Ines |last6=McGovern |first6=Eavan |last7=O'Riordan |first7=Sean |last8=Reilly |first8=Richard B |last9=Walsh |first9=Cathal |last10=Hutchinson |first10=Michael |date=2015-04-22 |title=Sun exposure is an environmental factor for the development of blepharospasm |url=http://dx.doi.org/10.1136/jnnp-2014-310266 |journal=Journal of Neurology, Neurosurgery & Psychiatry |volume=87 |issue=4 |pages=420–424 |doi=10.1136/jnnp-2014-310266 |issn=0022-3050 |pmid=25904812}}</ref> dry eyes,<ref name=":6">{{Cite journal |last1=Elsron |first1=J S |last2=Marsden |first2=C D |last3=Grandas |first3=F |last4=Quinn |first4=N P |date=July 1988 |title=The significance of ophthalmological symptoms in idiopathic blepharospasm |url=http://dx.doi.org/10.1038/eye.1988.79 |journal=Eye |volume=2 |issue=4 |pages=435–439 |doi=10.1038/eye.1988.79 |issn=0950-222X |pmid=3253136}}</ref> and burning sensation and grittiness in the eyes.<ref name=":4" /> Although such symptoms tend to precede the onset of the blepharospasm, the may both be due to a common third factor.<ref>{{Cite journal |last=Defazio |first=Giovanni |last2=Abbruzzese |first2=Giovanni |last3=Stella Aniello |first3=Maria |last4=Di Fede |first4=Roberta |last5=Esposito |first5=Marcello |last6=Fabbrini |first6=Giovanni |last7=Girlanda |first7=Paolo |last8=Liguori |first8=Rocco |last9=Marinelli |first9=Lucio |last10=Martino |first10=Davide |last11=Morgante |first11=Francesca |last12=Santoro |first12=Lucio |last13=Tinazzi |first13=Michele |last14=Berardelli |first14=Alfredo |date=2011-12-15 |title=Eye symptoms in relatives of patients with primary adult‐onset dystonia |url=http://dx.doi.org/10.1002/mds.24026 |journal=Movement Disorders |volume=27 |issue=2 |pages=305–307 |doi=10.1002/mds.24026 |issn=0885-3185}}</ref>
+Patients suffering from blepharospasm also report sensory symptoms including sensitivity to light,<ref>{{cite journal |vauthors=Adams WH, Digre KB, Patel BC, Anderson RL, Warner JE, Katz BJ |date=July 2006 |title=The evaluation of light sensitivity in benign essential blepharospasm |journal=American Journal of Ophthalmology |volume=142 |issue=1 |pages=82–87 |doi=10.1016/j.ajo.2006.02.020 |pmid=16815254}}</ref><ref>{{Cite journal |last1=Molloy |first1=Anna |last2=Williams |first2=Laura |last3=Kimmich |first3=Okka |last4=Butler |first4=John S |last5=Beiser |first5=Ines |last6=McGovern |first6=Eavan |last7=O'Riordan |first7=Sean |last8=Reilly |first8=Richard B |last9=Walsh |first9=Cathal |last10=Hutchinson |first10=Michael |date=2015-04-22 |title=Sun exposure is an environmental factor for the development of blepharospasm |url=http://dx.doi.org/10.1136/jnnp-2014-310266 |journal=Journal of Neurology, Neurosurgery & Psychiatry |volume=87 |issue=4 |pages=420–424 |doi=10.1136/jnnp-2014-310266 |issn=0022-3050 |pmid=25904812}}</ref> dry eyes,<ref name=":6">{{Cite journal |last1=Elsron |first1=J S |last2=Marsden |first2=C D |last3=Grandas |first3=F |last4=Quinn |first4=N P |date=July 1988 |title=The significance of ophthalmological symptoms in idiopathic blepharospasm |url=http://dx.doi.org/10.1038/eye.1988.79 |journal=Eye |volume=2 |issue=4 |pages=435–439 |doi=10.1038/eye.1988.79 |issn=0950-222X |pmid=3253136}}</ref> and burning sensation and grittiness in the eyes.<ref name=":4" /> Although such symptoms tend to precede the onset of the blepharospasm, they may both be due to a common third factor.<ref>{{Cite journal |last1=Defazio |first1=Giovanni |last2=Abbruzzese |first2=Giovanni |last3=Stella Aniello |first3=Maria |last4=Di Fede |first4=Roberta |last5=Esposito |first5=Marcello |last6=Fabbrini |first6=Giovanni |last7=Girlanda |first7=Paolo |last8=Liguori |first8=Rocco |last9=Marinelli |first9=Lucio |last10=Martino |first10=Davide |last11=Morgante |first11=Francesca |last12=Santoro |first12=Lucio |last13=Tinazzi |first13=Michele |last14=Berardelli |first14=Alfredo |date=2011-12-15 |title=Eye symptoms in relatives of patients with primary adult-onset dystonia |url=http://dx.doi.org/10.1002/mds.24026 |journal=Movement Disorders |volume=27 |issue=2 |pages=305–307 |doi=10.1002/mds.24026 |pmid=22173654 |issn=0885-3185}}</ref>
-Typically, the symptoms---spasms and contractions of the eyelids---tend to worsen when the patient relaxes but abate during sleep.<ref name=":5">{{Cite journal |last1=Defazio |first1=Giovanni |last2=Livrea |first2=Paolo |date=2004 |title=Primary Blepharospasm |url=http://dx.doi.org/10.2165/00003495-200464030-00002 |journal=Drugs |volume=64 |issue=3 |pages=237–244 |doi=10.2165/00003495-200464030-00002 |issn=0012-6667}}</ref> The symptoms may be temporarily alleviated by sensory tricks (geste antagoniste) including stretching or rubbing the eyebrows, eyelids, or forehead,<ref>{{Cite journal |last1=Martino |first1=Davide |last2=Liuzzi |first2=Daniele |last3=Macerollo |first3=Antonella |last4=Aniello |first4=Maria Stella |last5=Livrea |first5=Paolo |last6=Defazio |first6=Giovanni |date=2010-03-15 |title=The phenomenology of the geste antagoniste in primary blepharospasm and cervical dystonia |url=http://dx.doi.org/10.1002/mds.23011 |journal=Movement Disorders |volume=25 |issue=4 |pages=407–412 |doi=10.1002/mds.23011 |issn=0885-3185 |pmid=20108367}}</ref> and singing, talking, or humming.<ref>{{Cite journal |last1=Peckham |first1=E. L. |last2=Lopez |first2=G. |last3=Shamim |first3=E. A. |last4=Richardson |first4=S. Pirio |last5=Sanku |first5=S. |last6=Malkani |first6=R. |last7=Stacy |first7=M. |last8=Mahant |first8=P. |last9=Crawley |first9=A. |last10=Singleton |first10=A. |last11=Hallett |first11=M. |date=2011-02-17 |title=Clinical features of patients with blepharospasm: a report of 240 patients |url=http://dx.doi.org/10.1111/j.1468-1331.2010.03161.x |journal=European Journal of Neurology |volume=18 |issue=3 |pages=382–386 |doi=10.1111/j.1468-1331.2010.03161.x |issn=1351-5101 |pmc=3934127 |pmid=20649903}}</ref> Blepharospasm is aggravated by fatigue, stress, and environmental factors such as wind or air pollution.<ref>{{Cite journal |last=Coscarelli |first=Jandira Mourão |date=May 2010 |title=Essential Blepharospasm |url=http://www.tandfonline.com/doi/full/10.3109/08820538.2010.488564 |journal=Seminars in Ophthalmology |language=en |volume=25 |issue=3 |pages=104–108 |doi=10.3109/08820538.2010.488564 |issn=0882-0538}}</ref>
+Typically, the symptoms---spasms and contractions of the eyelids---tend to worsen when the patient relaxes but abate during sleep.<ref name=":5">{{Cite journal |last1=Defazio |first1=Giovanni |last2=Livrea |first2=Paolo |date=2004 |title=Primary Blepharospasm |url=http://dx.doi.org/10.2165/00003495-200464030-00002 |journal=Drugs |volume=64 |issue=3 |pages=237–244 |doi=10.2165/00003495-200464030-00002 |pmid=14871168 |issn=0012-6667}}</ref> The symptoms may be temporarily alleviated by sensory tricks (geste antagoniste) including stretching or rubbing the eyebrows, eyelids, or forehead,<ref>{{Cite journal |last1=Martino |first1=Davide |last2=Liuzzi |first2=Daniele |last3=Macerollo |first3=Antonella |last4=Aniello |first4=Maria Stella |last5=Livrea |first5=Paolo |last6=Defazio |first6=Giovanni |date=2010-03-15 |title=The phenomenology of the geste antagoniste in primary blepharospasm and cervical dystonia |url=http://dx.doi.org/10.1002/mds.23011 |journal=Movement Disorders |volume=25 |issue=4 |pages=407–412 |doi=10.1002/mds.23011 |issn=0885-3185 |pmid=20108367}}</ref> and singing, talking, or humming.<ref>{{Cite journal |last1=Peckham |first1=E. L. |last2=Lopez |first2=G. |last3=Shamim |first3=E. A. |last4=Richardson |first4=S. Pirio |last5=Sanku |first5=S. |last6=Malkani |first6=R. |last7=Stacy |first7=M. |last8=Mahant |first8=P. |last9=Crawley |first9=A. |last10=Singleton |first10=A. |last11=Hallett |first11=M. |date=2011-02-17 |title=Clinical features of patients with blepharospasm: a report of 240 patients |url=http://dx.doi.org/10.1111/j.1468-1331.2010.03161.x |journal=European Journal of Neurology |volume=18 |issue=3 |pages=382–386 |doi=10.1111/j.1468-1331.2010.03161.x |issn=1351-5101 |pmc=3934127 |pmid=20649903}}</ref> Blepharospasm is aggravated by fatigue, stress, and environmental factors such as wind or air pollution.<ref>{{Cite journal |last=Coscarelli |first=Jandira Mourão |date=May 2010 |title=Essential Blepharospasm |url=http://www.tandfonline.com/doi/full/10.3109/08820538.2010.488564 |journal=Seminars in Ophthalmology |language=en |volume=25 |issue=3 |pages=104–108 |doi=10.3109/08820538.2010.488564 |pmid=20590421 |issn=0882-0538}}</ref>
-Although blepharospasm is defined as a bilaterally symmetric disorder that affects both eyes, some research has reported unilateral onset.<ref>{{Cite journal |last=Grandas |first=F |last2=Elston |first2=J |last3=Quinn |first3=N |last4=Marsden |first4=C D |date=1988-06-01 |title=Blepharospasm: a review of 264 patients. |url=http://dx.doi.org/10.1136/jnnp.51.6.767 |journal=Journal of Neurology, Neurosurgery &amp; Psychiatry |volume=51 |issue=6 |pages=767–772 |doi=10.1136/jnnp.51.6.767 |issn=0022-3050}}</ref><ref>{{Cite journal |last=Hwang |first=WJ |date=2012 |title=Demographic and Clinical Features of Patients with Blepharospasm in Southern Taiwan: a university Hospital-Based Study |journal=Acta Neurol Taiwan |volume=21 |pages=108-114 |via=PubMed: 23196730}}</ref>
+Although blepharospasm is defined as a bilaterally symmetric disorder that affects both eyes, some research has reported unilateral onset.<ref name=":10">{{Cite journal |last1=Grandas |first1=F |last2=Elston |first2=J |last3=Quinn |first3=N |last4=Marsden |first4=C D |date=1988-06-01 |title=Blepharospasm: a review of 264 patients. |url=http://dx.doi.org/10.1136/jnnp.51.6.767 |journal=Journal of Neurology, Neurosurgery & Psychiatry |volume=51 |issue=6 |pages=767–772 |doi=10.1136/jnnp.51.6.767 |pmid=3404184 |issn=0022-3050|pmc=1033145 }}</ref><ref>{{Cite journal |last=Hwang |first=WJ |date=2012 |title=Demographic and Clinical Features of Patients with Blepharospasm in Southern Taiwan: a university Hospital-Based Study |journal=Acta Neurol Taiwan |volume=21 |issue=3 |pages=108–114 |pmid=23196730 }}</ref>
 ==Causes==
+Historically, it was believed that blepharospasm was due to the abnormal functioning of the brain's [[basal ganglia]].<ref>{{Cite journal |last=Marsden |first=C D |date=1976-12-01 |title=Blepharospasm-oromandibular dystonia syndrome (Brueghel's syndrome). A variant of adult-onset torsion dystonia? |url=http://dx.doi.org/10.1136/jnnp.39.12.1204 |journal=Journal of Neurology, Neurosurgery & Psychiatry |volume=39 |issue=12 |pages=1204–1209 |doi=10.1136/jnnp.39.12.1204 |pmid=1011031 |issn=0022-3050|pmc=492566 }}</ref> The basal ganglia are structures in the brain that are involved in the regulation of motor and reward functions.
-Some causes of blepharospasm have been identified; however, the causes of many cases of blepharospasm remain unknown. Some people with blepharospasm have a history of [[dry eyes]], [[light sensitivity]], and even [[fatigue]]. Others report no eye problems before onset of symptoms.
+However, blepharospasm is now known to involve several regions of the brain and to be a multifactorial condition in which "one or several as yet unknown genes together with epigenetic and environmental factors combine to reach the threshold that induces the disease".<ref name=":8" />
-Some drugs can induce blepharospasm, such as [[Management of Parkinson's disease#Medication|those used to treat]] [[Parkinson's disease]], as well as hormone treatments, including [[estrogen-replacement therapy]] for women going through menopause. Blepharospasm can also be a symptom of acute [[benzodiazepine dependence|withdrawal from benzodiazepines]]. Prolonged use of [[benzodiazepines]] can induce blepharospasm and is a known risk factor for the development of blepharospasm.<ref>{{cite journal |vauthors=Wakakura M, Tsubouchi T, Inouye J |title=Etizolam and benzodiazepine induced blepharospasm |journal=Journal of Neurology, Neurosurgery, and Psychiatry |volume=75 |issue=3 |pages=506–507 |date = March 2004|pmid=14966178 |pmc=1738986 |doi=10.1136/jnnp.2003.019869}}</ref>
+Blepharospasm is often associated with dry eyes, but the causal mechanism is still not clear.<ref name=":6" /><ref name=":1" /> Research in New York and Italy suggests that increased blinking (which may be triggered by dry eyes) leads to blepharospasm.<ref name=":7">{{Cite journal |last1=Evinger |first1=Craig |last2=Bao |first2=Jian-Bin |last3=Powers |first3=Alice S. |last4=Kassem |first4=Iris S. |last5=Schicatano |first5=Edward J. |last6=Henriquez |first6=Victor M. |last7=Peshori |first7=Kavita R. |date=2002-01-31 |title=Dry eye, blinking, and blepharospasm |url=http://dx.doi.org/10.1002/mds.10065 |journal=Movement Disorders |volume=17 |issue=S2 |pages=S75–S78 |doi=10.1002/mds.10065 |issn=0885-3185 |pmc=3327285 |pmid=11836761}}</ref><ref>{{Cite journal |last1=Conte |first1=Antonella |last2=Ferrazzano |first2=Gina |last3=Defazio |first3=Giovanni |last4=Fabbrini |first4=Giovanni |last5=Hallett |first5=Mark |last6=Berardelli |first6=Alfredo |date=2017-06-02 |title=Increased Blinking May Be a Precursor of Blepharospasm: A Longitudinal Study |url=http://dx.doi.org/10.1002/mdc3.12499 |journal=Movement Disorders Clinical Practice |volume=4 |issue=5 |pages=733–736 |doi=10.1002/mdc3.12499 |pmid=29082270 |issn=2330-1619 |pmc=5654574}}</ref> A case control study in China found that blepharospasm aggravated dry eyes.<ref>{{Cite journal |last1=Lu |first1=Rong |last2=Huang |first2=Ruisheng |last3=Li |first3=Kang |last4=Zhang |first4=Xinchun |last5=Yang |first5=Hui |last6=Quan |first6=Yadan |last7=Li |first7=Qian |date=March 2014 |title=The Influence of Benign Essential Blepharospasm on Dry Eye Disease and Ocular Inflammation |url=http://dx.doi.org/10.1016/j.ajo.2013.11.014 |journal=American Journal of Ophthalmology |volume=157 |issue=3 |pages=591–597.e2 |doi=10.1016/j.ajo.2013.11.014 |pmid=24269849 |issn=0002-9394}}</ref>
-Blepharospasm may also come from abnormal functioning of the brain's [[basal ganglia]].<ref>{{Cite web|url=https://rarediseases.org/rare-diseases/benign-essential-blepharospasm/|title=Benign Essential Blepharospasm|website=NORD (National Organization for Rare Disorders)|language=en-US|access-date=2020-01-29}}</ref> Simultaneous dry eye and [[dystonia]]s such as [[Meige's syndrome]] have been observed. Blepharospasms can be caused by [[concussion]]s in some rare cases, when a blow to the back of the head damages the basal ganglia.<ref>{{Cite journal|last1=Martino|first1=Davide|last2=Defazio|first2=Giovanni|last3=Abbruzzese|first3=Giovanni|last4=Girlanda|first4=Paolo|last5=Tinazzi|first5=Michele|last6=Fabbrini|first6=Giovanni|last7=Aniello|first7=Maria Stella|last8=Avanzino|first8=Laura|last9=Colosimo|first9=Carlo|last10=Majorana|first10=Giuseppe|last11=Trompetto|first11=Carlo|date=March 2007|title=Head trauma in primary cranial dystonias: a multicentre case–control study|journal=Journal of Neurology, Neurosurgery, and Psychiatry|volume=78|issue=3|pages=260–263|doi=10.1136/jnnp.2006.103713|issn=0022-3050|pmc=2117628|pmid=17056625}}</ref>
+Blepharospasm may be associated with dystonia in other parts of the body, particularly [[Meige's syndrome|Meige's Syndrome]].<ref>{{Cite journal |last1=Jankovic |first1=Joseph |last2=Ford |first2=Janet |date=April 1983 |title=Blepharospasm and orofacial-cervical dystonia: Clinical and pharmacological findings in 100 patients |url=https://onlinelibrary.wiley.com/doi/10.1002/ana.410130406 |journal=Annals of Neurology |language=en |volume=13 |issue=4 |pages=402–411 |doi=10.1002/ana.410130406 |pmid=6838174 |issn=0364-5134}}</ref><ref>{{Cite journal |last1=Abbruzzese |first1=G |last2=Berardelli |first2=A |last3=Girlanda |first3=P |last4=Marchese |first4=R |last5=Martino |first5=D |last6=Morgante |first6=F |last7=Avanzino |first7=L |last8=Colosimo |first8=C |last9=Defazio |first9=G |date=2008-04-01 |title=Long-term assessment of the risk of spread in primary late-onset focal dystonia |url=http://dx.doi.org/10.1136/jnnp.2007.124594 |journal=Journal of Neurology, Neurosurgery & Psychiatry |volume=79 |issue=4 |pages=392–396 |doi=10.1136/jnnp.2007.124594 |pmid=17635969 |issn=0022-3050}}</ref><ref name=":4" /> Blepharospasm may be associated with [[Parkinson's disease|Parkinson's Disease]], but the causal mechanism is still not clear.<ref>{{Cite journal |last1=Micheli |first1=Federico |last2=Scorticati |first2=María Clara |last3=Folgar |first3=Silvia |last4=Gatto |first4=Emilia |date=September 2004 |title=Development of Parkinson's disease in patients with blepharospasm |url=https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.20084 |journal=Movement Disorders |language=en |volume=19 |issue=9 |pages=1069–1072 |doi=10.1002/mds.20084 |pmid=15372598 |issn=0885-3185}}</ref><ref>{{Cite journal |last1=Rana |first1=Abdul-Qayyum |last2=Kabir |first2=Ashish |last3=Dogu |first3=Okan |last4=Patel |first4=Ami |last5=Khondker |first5=Sumaiya |date=2012-10-11 |title=Prevalence of Blepharospasm and Apraxia of Eyelid Opening in Patients with Parkinsonism, Cervical Dystonia and Essential Tremor |url=https://doi.org/10.1159/000341621 |journal=European Neurology |volume=68 |issue=5 |pages=318–321 |doi=10.1159/000341621 |pmid=23075668 |issn=0014-3022}}</ref>  In rare cases, blepharospasm is associated with [[multiple sclerosis]].<ref>{{Cite journal |last1=Nociti |first1=V |last2=Bentivoglio |first2=Ar |last3=Frisullo |first3=G |last4=Fasano |first4=A |last5=Soleti |first5=F |last6=Iorio |first6=R |last7=Loria |first7=G |last8=Patanella |first8=Ak |last9=Marti |first9=A |last10=Tartaglione |first10=T |last11=Tonali |first11=Pa |last12=Batocchi |first12=Ap |date=November 2008 |title=Movement disorders in multiple sclerosis: causal or coincidental association? |url=http://journals.sagepub.com/doi/10.1177/1352458508094883 |journal=Multiple Sclerosis Journal |language=en |volume=14 |issue=9 |pages=1284–1287 |doi=10.1177/1352458508094883 |pmid=18768580 |issn=1352-4585}}</ref><ref>{{Cite journal |last1=Edechi |first1=Chidalu A. |last2=Micieli |first2=Jonathan A. |date=2022-04-28 |title=Blepharospasm and Sixth Nerve Palsy as the Presenting Sign of Multiple Sclerosis |url=https://journals.lww.com/jneuro-ophthalmology/citation/9900/blepharospasm_and_sixth_nerve_palsy_as_the.389.aspx |journal=Journal of Neuro-Ophthalmology |language=en-US |pages=10.1097/WNO.0000000000001916 |doi=10.1097/WNO.0000000000001916 |pmid=37389956 |issn=1070-8022}}</ref>
-[[Multiple sclerosis]] can cause blepharospasm.<ref name=Cecil>{{cite book|last=Goldman|first=Lee|title=Goldman's Cecil Medicine|publisher=Elsevier Saunders|location=Philadelphia|isbn=978-1437727883|page=2429|edition=24th|date=25 July 2011}}</ref>
-Blepharospasm is often associated with dry eyes, but the causal mechanism is still not clear.<ref name=":6" /><ref name=":1" /> Research in New York and Italy suggest that increased blinking (which may be triggered by dry eyes) leads to blepharospasm.<ref name=":7">{{Cite journal |last1=Evinger |first1=Craig |last2=Bao |first2=Jian-Bin |last3=Powers |first3=Alice S. |last4=Kassem |first4=Iris S. |last5=Schicatano |first5=Edward J. |last6=Henriquez |first6=Victor M. |last7=Peshori |first7=Kavita R. |date=2002-01-31 |title=Dry eye, blinking, and blepharospasm |url=http://dx.doi.org/10.1002/mds.10065 |journal=Movement Disorders |volume=17 |issue=S2 |pages=S75–S78 |doi=10.1002/mds.10065 |issn=0885-3185 |pmc=3327285 |pmid=11836761}}</ref><ref>{{Cite journal |last=Conte |first=Antonella |last2=Ferrazzano |first2=Gina |last3=Defazio |first3=Giovanni |last4=Fabbrini |first4=Giovanni |last5=Hallett |first5=Mark |last6=Berardelli |first6=Alfredo |date=2017-06-02 |title=Increased Blinking May Be a Precursor of Blepharospasm: A Longitudinal Study |url=http://dx.doi.org/10.1002/mdc3.12499 |journal=Movement Disorders Clinical Practice |volume=4 |issue=5 |pages=733–736 |doi=10.1002/mdc3.12499 |issn=2330-1619}}</ref> A case control study in China shows that blepharospasm aggravates dry eyes.<ref>{{Cite journal |last=Lu |first=Rong |last2=Huang |first2=Ruisheng |last3=Li |first3=Kang |last4=Zhang |first4=Xinchun |last5=Yang |first5=Hui |last6=Quan |first6=Yadan |last7=Li |first7=Qian |date=March 2014 |title=The Influence of Benign Essential Blepharospasm on Dry Eye Disease and Ocular Inflammation |url=http://dx.doi.org/10.1016/j.ajo.2013.11.014 |journal=American Journal of Ophthalmology |volume=157 |issue=3 |pages=591–597.e2 |doi=10.1016/j.ajo.2013.11.014 |issn=0002-9394}}</ref>
+Some drugs can induce blepharospasm, including those used to treat depression<ref name=":11">{{cite journal |vauthors=Wakakura M, Tsubouchi T, Inouye J |date=March 2004 |title=Etizolam and benzodiazepine induced blepharospasm |journal=Journal of Neurology, Neurosurgery, and Psychiatry |volume=75 |issue=3 |pages=506–507 |doi=10.1136/jnnp.2003.019869 |pmc=1738986 |pmid=14966178}}</ref><ref name=":12">{{Cite journal |last1=Wakakura |first1=M. |last2=Yamagami |first2=A. |last3=Iwasa |first3=M. |date=2018-09-03 |title=Blepharospasm in Japan: A Clinical Observational Study From a Large Referral Hospital in Tokyo |journal=Neuro-Ophthalmology |language=en |volume=42 |issue=5 |pages=275–283 |doi=10.1080/01658107.2017.1409770 |issn=0165-8107 |pmc=6152494 |pmid=30258472}}</ref> and Parkinson's disease.<ref>{{Cite journal |last1=Mauriello |first1=Joseph A. |last2=Carbonaro |first2=Paul |last3=Dhillon |first3=Shamina |last4=Leone |first4=Tina |last5=Franklin |first5=Mark |date=June 1998 |title=Drug-Associated Facial Dyskinesias—A Study of 238 Patients |url=https://journals.lww.com/jneuro-ophthalmology/abstract/1998/06000/Drug_Associated_Facial_Dyskinesias_A_Study_of_238.16.aspx |journal=Journal of Neuro-Ophthalmology |language=en-US |volume=18 |issue=2 |pages=153–157 |doi=10.1097/00041327-199806000-00016 |pmid=9621275 |issn=1070-8022}}</ref> [[Estrogen-replacement therapy|Hormone replacement therapy]] for women going through menopause has been found to be associated with dry eyes,<ref name=":9">{{Cite journal |last=Liesegang |first=Thomas J |date=March 2002 |title=Hormone replacement therapy and dry eye syndrome. Schaumberg DA,∗∗Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Ave E, Boston, MA 02215. USA E-mail: [email protected] Buring JE, Sullivan DA, Dana MR. JAMA 2001;286:2114–2119. |url=http://dx.doi.org/10.1016/s0002-9394(02)01368-5 |journal=American Journal of Ophthalmology |volume=133 |issue=3 |pages=435–436 |doi=10.1016/s0002-9394(02)01368-5 |issn=0002-9394}}</ref> which in turn is associated with blepharospasm.
-In many cases, blepharospasm is associated with dystonia in other parts of the body.<ref>{{Cite journal |last=Abbruzzese |first=G |last2=Berardelli |first2=A |last3=Girlanda |first3=P |last4=Marchese |first4=R |last5=Martino |first5=D |last6=Morgante |first6=F |last7=Avanzino |first7=L |last8=Colosimo |first8=C |last9=Defazio |first9=G |date=2008-04-01 |title=Long-term assessment of the risk of spread in primary late-onset focal dystonia |url=http://dx.doi.org/10.1136/jnnp.2007.124594 |journal=Journal of Neurology, Neurosurgery &amp; Psychiatry |volume=79 |issue=4 |pages=392–396 |doi=10.1136/jnnp.2007.124594 |issn=0022-3050}}</ref><ref name=":4" />
+Blepharospasm can be caused by [[concussion]]s in some rare cases, when a blow to the back of the head damages the basal ganglia.<ref>{{Cite journal|last1=Martino|first1=Davide|last2=Defazio|first2=Giovanni|last3=Abbruzzese|first3=Giovanni|last4=Girlanda|first4=Paolo|last5=Tinazzi|first5=Michele|last6=Fabbrini|first6=Giovanni|last7=Aniello|first7=Maria Stella|last8=Avanzino|first8=Laura|last9=Colosimo|first9=Carlo|last10=Majorana|first10=Giuseppe|last11=Trompetto|first11=Carlo|date=March 2007|title=Head trauma in primary cranial dystonias: a multicentre case–control study|journal=Journal of Neurology, Neurosurgery, and Psychiatry|volume=78|issue=3|pages=260–263|doi=10.1136/jnnp.2006.103713|issn=0022-3050|pmc=2117628|pmid=17056625}}</ref>
+Blepharospasm is associated with exposure to the sun.<ref>{{Cite journal |last1=Molloy |first1=Anna |last2=Williams |first2=Laura |last3=Kimmich |first3=Okka |last4=Butler |first4=John S. |last5=Beiser |first5=Ines |last6=McGovern |first6=Eavan |last7=O'Riordan |first7=Sean |last8=Reilly |first8=Richard B. |last9=Walsh |first9=Cathal |last10=Hutchinson |first10=Michael |date=2016-04-01 |title=Sun exposure is an environmental factor for the development of blepharospasm |url=https://jnnp.bmj.com/content/87/4/420 |journal=Journal of Neurology, Neurosurgery & Psychiatry |language=en |volume=87 |issue=4 |pages=420–424 |doi=10.1136/jnnp-2014-310266 |issn=0022-3050 |pmid=25904812}}</ref>
 == Diagnosis ==
-Historically, blepharospasm was frequently misdiagnosed,<ref name=":5" /> often as a psychiatric condition.<ref name=":0" />
+No laboratory tests exist with which to definitively diagnose blepharospasm. Historically, the condition was frequently misdiagnosed,<ref name=":5" /> often as a psychiatric condition.<ref name=":0" />
-Diagnosis has been enhanced by the proposal of objective criteria that start from "stereotyped, bilateral and synchronous orbicularis oculi spasms" and proceed to the identification of a "sensory trick" or "increased blinking".<ref>{{Cite journal |last=Defazio |first=Giovanni |last2=Hallett |first2=Mark |last3=Jinnah |first3=Hyder A. |last4=Berardelli |first4=Alfredo |date=2013-07-16 |title=Development and validation of a clinical guideline for diagnosing blepharospasm |url=http://dx.doi.org/10.1212/wnl.0b013e31829bfdf6 |journal=Neurology |volume=81 |issue=3 |pages=236–240 |doi=10.1212/wnl.0b013e31829bfdf6 |issn=0028-3878}}</ref> The criteria have been validated diagnostic across multiple ethnicities in multiple centers.<ref>{{Cite journal |last=Defazio |first=Giovanni |last2=Jinnah |first2=Hyder A. |last3=Berardelli |first3=Alfredo |last4=Perlmutter |first4=Joel S. |last5=Berkmen |first5=Gamze Kilic |last6=Berman |first6=Brian D. |last7=Jankovic |first7=Joseph |last8=Bäumer |first8=Tobias |last9=Comella |first9=Cynthia |last10=Cotton |first10=Adam C. |last11=Ercoli |first11=Tommaso |last12=Ferrazzano |first12=Gina |last13=Fox |first13=Susan |last14=Kim |first14=Han-Joon |last15=Moukheiber |first15=Emile Sami |date=October 2021 |title=Diagnostic criteria for blepharospasm: A multicenter international study |url=http://dx.doi.org/10.1016/j.parkreldis.2021.09.004 |journal=Parkinsonism &amp; Related Disorders |volume=91 |pages=109–114 |doi=10.1016/j.parkreldis.2021.09.004 |issn=1353-8020}}</ref>
+Diagnosis of blepharospasm has been enhanced by the proposal of objective diagnostic criteria that start from "stereotyped, bilateral and synchronous orbicularis oculi spasms" and proceed to the identification of a "sensory trick" or "increased blinking".<ref>{{Cite journal |last1=Defazio |first1=Giovanni |last2=Hallett |first2=Mark |last3=Jinnah |first3=Hyder A. |last4=Berardelli |first4=Alfredo |date=2013-07-16 |title=Development and validation of a clinical guideline for diagnosing blepharospasm |url=http://dx.doi.org/10.1212/wnl.0b013e31829bfdf6 |journal=Neurology |volume=81 |issue=3 |pages=236–240 |doi=10.1212/wnl.0b013e31829bfdf6 |pmid=23771487 |issn=0028-3878|pmc=3770163 }}</ref> The criteria have been validated across multiple ethnicities in multiple centers.<ref>{{Cite journal |last1=Defazio |first1=Giovanni |last2=Jinnah |first2=Hyder A. |last3=Berardelli |first3=Alfredo |last4=Perlmutter |first4=Joel S. |last5=Berkmen |first5=Gamze Kilic |last6=Berman |first6=Brian D. |last7=Jankovic |first7=Joseph |last8=Bäumer |first8=Tobias |last9=Comella |first9=Cynthia |last10=Cotton |first10=Adam C. |last11=Ercoli |first11=Tommaso |last12=Ferrazzano |first12=Gina |last13=Fox |first13=Susan |last14=Kim |first14=Han-Joon |last15=Moukheiber |first15=Emile Sami |date=October 2021 |title=Diagnostic criteria for blepharospasm: A multicenter international study |url=http://dx.doi.org/10.1016/j.parkreldis.2021.09.004 |journal=Parkinsonism & Related Disorders |volume=91 |pages=109–114 |doi=10.1016/j.parkreldis.2021.09.004 |pmid=34583301 |issn=1353-8020|pmc=9048224 }}</ref>
 ==Treatment==
+Standard first line treatments of blepharospasm are conservative therapies, oral medication, and periodic injections of botulinum toxin.
-Drug therapy for blepharospasm has proved generally unpredictable and short-termed. Anticholinergics, tranquillizing drugs and botulinum toxin are the mostly used therapeutic options. However serious side effects can be observed as well as failure of therapy. It is therefore not surprising that new therapies are constantly being tested. In this backdrop new evidence shows [[Mosapride]] can be a safe and affordable therapeutic option for blepharospasm.<ref>{{cite journal |author1=Piyasena INAP |author2=Jayasinghe JAC |title=Mosapride (5HT4 agonist) in the treatment of blepharospasm. |journal=Ceylon Med J. |volume=59 |issue=1 |pages=26–27 |date = March 2014|pmid=24682196  |doi=10.4038/cmj.v59i1.5527|doi-access=free }}</ref>
+Particularly when associated with dry eyes, blepharospasm may be relieved with warm compresses, eye drops, and eye wipes.<ref>{{Cite journal |last1=Murakami |first1=David K. |last2=Blackie |first2=Caroline A. |last3=Korb |first3=Donald R. |date=September 2015 |title=All Warm Compresses Are Not Equally Efficacious |url=https://journals.lww.com/optvissci/abstract/2015/09000/all_warm_compresses_are_not_equally_efficacious.29.aspx |journal=Optometry and Vision Science |language=en-US |volume=92 |issue=9 |pages=e327 |doi=10.1097/OPX.0000000000000675 |pmid=26164316 |issn=1538-9235}}</ref><ref>{{Cite journal |last1=Defazio |first1=Giovanni |last2=Livrea |first2=Paolo |date=2004-02-01 |title=Primary Blepharospasm |url=https://doi.org/10.2165/00003495-200464030-00002 |journal=Drugs |language=en |volume=64 |issue=3 |pages=237–244 |doi=10.2165/00003495-200464030-00002 |pmid=14871168 |issn=1179-1950}}</ref> A Japanese study showed that warm compresses containing menthol were more effective in increasing tear film.<ref>{{Cite journal |last1=Arita |first1=Reiko |last2=Morishige |first2=Naoyuki |last3=Sakamoto |first3=Ichiro |last4=Imai |first4=Natsuko |last5=Shimada |first5=Yuko |last6=Igaki |first6=Michihito |last7=Suzuki |first7=Atsushi |last8=Itoh |first8=Kouzo |last9=Tsubota |first9=Kazuo |date=2017-04-05 |title=Effects of a warm compress containing menthol on the tear film in healthy subjects and dry eye patients |journal=Scientific Reports |language=en |volume=7 |issue=1 |pages=45848 |doi=10.1038/srep45848 |pmid=28378793 |issn=2045-2322|pmc=5381094 |bibcode=2017NatSR...745848A }}</ref>
-[[Botulinum toxin]] injections have been used to induce localized, partial paralysis. Among most sufferers, botulinum toxin injection is the preferred treatment method.<ref>{{cite journal |vauthors=Schellini SA, Matai O, Igami TZ, Padovani CR, Padovani CP |title=Blefarospasmo essencial e espasmo hemifacial: características dos pacientes, tratamento com toxina botulínica A e revisão da literatura |trans-title=Essential blepharospasm and hemifacial spasm: characteristic of the patient, botulinum toxin A treatment and literature review |language=pt |journal=Arquivos Brasileiros de Oftalmologia |volume=69 |issue=1 |pages=23–26 |year=2006 |pmid=16491229 |doi=10.1590/S0004-27492006000100005|doi-access=free |hdl=11449/68714 |hdl-access=free }}</ref> Injections are generally administered every three months, with variations based on patient response and usually give almost immediate relief (though for some it may take more than a week) of symptoms from the muscle spasms. Most patients can resume a relatively normal life with regular botulinum toxin treatments. A minority of sufferers develop minimal or no result from botulinum toxin injections and have to find other treatments. For some, botulinum toxin diminishes in its effectiveness after many years of use. An observed side effect in a minority of patients is [[Ptosis (eyelid)|''ptosis'']] or eyelid droop. Attempts to inject in locations that minimize ptosis can result in diminished ability to control spasms. A recent Cochrane systematic review showed that a single treatment session (where both eyelids were injected with BtA multiple times) alleviated the symptoms of blepharospasm, disability, and number of involuntary movements.<ref>{{Cite journal|last1=Duarte|first1=Gonçalo S|last2=Rodrigues|first2=Filipe B|last3=Marques|first3=Raquel E|last4=Castelão|first4=Mafalda|last5=Ferreira|first5=Joaquim|last6=Sampaio|first6=Cristina|last7=Moore|first7=Austen P|last8=Costa|first8=João|date=2020-11-19|editor-last=Cochrane Movement Disorders Group|title=Botulinum toxin type A therapy for blepharospasm|journal=Cochrane Database of Systematic Reviews|volume=2020|issue=11|pages=CD004900|language=en|doi=10.1002/14651858.CD004900.pub3|pmid=33211907|pmc=8094161}}</ref>
+Drugs used to treat blepharospasm are anticholinergics, benzodiazepines, baclofen, and tetrabenazine.<ref name=":14">{{Cite journal |last1=Vijayakumar |first1=Dhanya |last2=Jankovic |first2=Joseph |date=2018-07-04 |title=Medical treatment of blepharospasm |url=https://www.tandfonline.com/doi/full/10.1080/17469899.2018.1503535 |journal=Expert Review of Ophthalmology |language=en |volume=13 |issue=4 |pages=233–243 |doi=10.1080/17469899.2018.1503535 |issn=1746-9899}}</ref> The proportion of patients who benefited from anticholinergics ranged from 1 in 9 in Oregon<ref>{{Cite journal |last1=Nutt |first1=John G. |last2=Hammerstad |first2=John P. |last3=de Garmo |first3=Pat |last4=Carter |first4=Julie |date=February 1984 |title=Cranial dystonia: Double-blind crossover study of anticholinergics |url=https://www.neurology.org/doi/10.1212/WNL.34.2.215 |journal=Neurology |language=en |volume=34 |issue=2 |pages=215–217 |doi=10.1212/WNL.34.2.215 |pmid=6363970 |issn=0028-3878}}</ref> to 1 in 5 in England.<ref name=":10" /> Besides failing to resolve the blepharospasm, some drugs present the risk of side effects. In Japan, use of etizolam and benzodiazepine was associated with the development of blepharospasm.<ref name=":11" /><ref name=":12" /> A case report from Sri Lanka suggests treatment with [[Mosapride]].<ref>{{cite journal |author1=Piyasena INAP |author2=Jayasinghe JAC |title=Mosapride (5HT4 agonist) in the treatment of blepharospasm. |journal=Ceylon Med J. |volume=59 |issue=1 |pages=26–27 |date = March 2014|pmid=24682196  |doi=10.4038/cmj.v59i1.5527|doi-access=free }}</ref>
-People that do not respond well to medication or botulinum toxin injection are candidates for surgical therapy. The most effective surgical treatment has been ''protractor myectomy'', the removal of muscles responsible for eyelid closure.<ref>{{cite journal |vauthors=Anderson RL, Patel BC, Holds JB, Jordan DR |title=Blepharospasm: past, present, and future |journal=Ophthalmic Plastic and Reconstructive Surgery |volume=14 |issue=5 |pages=305–317 |date = September 1998|pmid=9783280 |doi=10.1097/00002341-199809000-00002|s2cid=13678666 }}</ref>
-Although there is no cure, [[botulinum toxin]] injections may help temporarily.<ref name="NIH2009">{{cite web |date=August 2009 |title=Facts About Blepharospasm |url=https://www.nei.nih.gov/health/blepha/blepharospasm |access-date=19 March 2015}}</ref><ref>{{cite journal |last1=Simpson |first1=D. M. |last2=Hallett |first2=M. |last3=Ashman |first3=E. J. |last4=Comella |first4=C. L. |last5=Green |first5=M. W. |last6=Gronseth |first6=G. S. |last7=Armstrong |first7=M. J. |last8=Gloss |first8=D. |last9=Potrebic |first9=S. |last10=Jankovic |first10=J. |last11=Karp |first11=B. P. |last12=Naumann |first12=M. |last13=So |first13=Y. T. |last14=Yablon |first14=S. A. |date=18 April 2016 |title=Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology |journal=Neurology |volume=86 |issue=19 |pages=1818–1826 |doi=10.1212/WNL.0000000000002560 |pmc=4862245 |pmid=27164716}}</ref> A surgical procedure known as [[myectomy]] may also be useful.<ref name="NIH2009" />
+The main first-line therapy is periodic injections of [[Botulinum toxin|botulinum toxin type A]] to induce localized, partial paralysis of the eyelid muscles.<ref name=":13">{{Cite journal |last1=Duarte |first1=Gonçalo S |last2=Rodrigues |first2=Filipe B |last3=Marques |first3=Raquel E |last4=Castelão |first4=Mafalda |last5=Ferreira |first5=Joaquim |last6=Sampaio |first6=Cristina |last7=Moore |first7=Austen P |last8=Costa |first8=João |date=2020-11-19 |editor-last=Cochrane Movement Disorders Group |title=Botulinum toxin type A therapy for blepharospasm |journal=Cochrane Database of Systematic Reviews |language=en |volume=2020 |issue=11 |pages=CD004900 |doi=10.1002/14651858.CD004900.pub3 |pmc=8094161 |pmid=33211907}}</ref><ref>{{cite journal |last1=Simpson |first1=D. M. |last2=Hallett |first2=M. |last3=Ashman |first3=E. J. |last4=Comella |first4=C. L. |last5=Green |first5=M. W. |last6=Gronseth |first6=G. S. |last7=Armstrong |first7=M. J. |last8=Gloss |first8=D. |last9=Potrebic |first9=S. |last10=Jankovic |first10=J. |last11=Karp |first11=B. P. |last12=Naumann |first12=M. |last13=So |first13=Y. T. |last14=Yablon |first14=S. A. |date=18 April 2016 |title=Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology |journal=Neurology |volume=86 |issue=19 |pages=1818–1826 |doi=10.1212/WNL.0000000000002560 |pmc=4862245 |pmid=27164716}}</ref> Injections are generally administered at intervals of around 10 weeks, with variations based on patient response and usually give fairly quick relief from the muscle spasms.  An English study reported that 118 (78%) of 151 patients experienced significant relief of symptoms for a mean duration of 9.2 weeks.<ref name=":10" /> However, in a minority of patients, the injections do not provide any symptomatic relief. Injections of botulinum toxin may diminish in effectiveness with prolonged use and require increased dosage.<ref>{{Cite journal |last1=Ababneh |first1=Osama H |last2=Cetinkaya |first2=Altug |last3=Kulwin |first3=Dwight R |date=April 2014 |title=Long-term efficacy and safety of botulinum toxin A injections to treat blepharospasm and hemifacial spasm |url=https://onlinelibrary.wiley.com/doi/10.1111/ceo.12165 |journal=Clinical & Experimental Ophthalmology |language=en |volume=42 |issue=3 |pages=254–261 |doi=10.1111/ceo.12165 |pmid=23844601 |issn=1442-6404}}</ref> Injections of botulinum toxin increase the risk of visual complaints and [[Ptosis (eyelid)|''ptosis'']] (eyelid droop).<ref name=":13" />
+Patients who do not respond well to medication or botulinum toxin injections are candidates for surgical therapy. The most effective surgical treatment has been ''protractor myectomy'', the removal of muscles responsible for eyelid closure.<ref>{{cite journal |vauthors=Anderson RL, Patel BC, Holds JB, Jordan DR |title=Blepharospasm: past, present, and future |journal=Ophthalmic Plastic and Reconstructive Surgery |volume=14 |issue=5 |pages=305–317 |date = September 1998|pmid=9783280 |doi=10.1097/00002341-199809000-00002|s2cid=13678666 }}</ref> Myectomy is more effective than distal neurectomy.<ref>{{Cite journal |last1=Waller |first1=R R |last2=Kennedy |first2=R H |last3=Henderson |first3=J W |last4=Kesty |first4=K R |date=1985 |title=Management of blepharospasm. |journal=Transactions of the American Ophthalmological Society |volume=83 |pages=367–386 |issn=0065-9533 |pmc=1298706 |pmid=3832534}}</ref>
-Since the root of the problem is neurological, doctors have explored sensorimotor retraining activities to enable the brain to "rewire" itself and eliminate dystonic movements. The work of [[Joaquin Farias]] has shown that sensorimotor retraining activities and proprioceptive stimulation can induce [[neuroplasticity]], making it possible for patients to recover substantial function that was lost due to blepharospasm.<ref>{{Cite book |last=Farias |first=Joaquin |title=Limitless. How your movements can heal your brain: An essay on the neurodynamics of dystonia |publisher=Mar Garcia Mejias: Galene Editions |year=2016 |isbn=978-0-9951701-0-0}}</ref><ref>{{Cite book |last=Farias |first=Joaquin |title=Intertwined. How to Induce Neuroplasticity: A New Approach to Rehabilitating Dystonias. |publisher=Galene Editions |year=2012 |isbn=978-8-4615512-4-8}}</ref><ref>Farias, J., Sarti-Martínez, MA. Title: "Elite musicians treated by specific fingers motion program to stimulate propiceptive sense", ''Congreso Nacional De La Sociedad Anatómica Española'', Alicante (España), ''European Journal of Anatomy'', p. 110</ref>
+A case report from California suggests the use of intense pulsed light therapy to relieve blepharospasm.<ref>{{Cite journal |last1=Monterastelli |first1=Anna N. |last2=Bailey |first2=Lucy A. |last3=Cockerham |first3=Kimberly |date=June 2022 |title=Intense Pulsed Light: A Therapeutic Option for Patients With Rosacea-Related Dry Eye and Blepharospasm |url=https://journals.lww.com/jneuro-ophthalmology/fulltext/2022/06000/Intense_Pulsed_Light__A_Therapeutic_Option_for.36.aspx |journal=Journal of Neuro-Ophthalmology |language=en-US |volume=42 |issue=2 |pages=e494–e496 |doi=10.1097/WNO.0000000000001290 |pmid=34270518 |issn=1070-8022}}</ref> Several complementary therapies simulate sensory tricks. One is to attach a device to spectacle frames to press on the patient's temple.<ref>{{Cite journal |last1=Fantato |first1=Alexina |last2=Parulekar |first2=Manoj |last3=Elston |first3=John |date=2019-07-02 |title=A trial of a mechanical device for the treatment of blepharospasm |url=http://dx.doi.org/10.1038/s41433-019-0495-y |journal=Eye |volume=33 |issue=11 |pages=1803–1808 |doi=10.1038/s41433-019-0495-y |pmid=31267089 |issn=0950-222X|pmc=7002569 }}</ref> Another is the application of thin cosmetic tapes to the forehead and eyebrows.<ref>{{Cite journal |last1=Uchida |first1=Kazuko |last2=Kiyosawa |first2=Motohiro |last3=Wakakura |first3=Masato |date=2020 |title=Efficacy of a Non-invasive Cosmetic Forcible Trick Treatment for Blepharospasm: Increase in Quality of Life Due to Use of Ultra-thin Adhesive Tape |url=https://doi.org/10.11476/shinkeiganka.37.237 |journal=NeuroOphthalmology Japan |volume=37 |issue=2 |pages=237–243 |doi=10.11476/shinkeiganka.37.237 |issn= |via=JStage}}</ref>
-* See also
+Another complementary therapy is retraining the brain to "rewire" itself and eliminate dystonic movements. Associated with [https://www.fariastechnique.com/ Joaquin Farias], sensorimotor retraining activities and proprioceptive stimulation aim to induce [[neuroplasticity]], making it possible for patients to recover substantial function that was lost due to blepharospasm.<ref>{{Cite book |last=Farias |first=Joaquin |title=Limitless. How your movements can heal your brain: An essay on the neurodynamics of dystonia |publisher=Galene Editions |year=2016 |isbn=978-0-9951701-0-0}}</ref><ref>Farias, J., Sarti-Martínez, MA. Title: "Elite musicians treated by specific fingers motion program to stimulate propiceptive sense", ''Congreso Nacional De La Sociedad Anatómica Española'', Alicante (España), ''European Journal of Anatomy'', p. 110</ref>
-* [[Levator palpebrae superioris muscle]]
-* [[Myokymia]]
-* [[Fasciculation]]
+Patients suffering from blepharospasm may get relief by wearing spectacles fitted to lift the upper eyelid.<ref name=":14" />
-==Multimedia==
-Neuroplasticity training
+==Research==
-* [https://www.youtube.com/watch?v=IpcXkV_ex8Y "Choosing music over meds, one man's quest to retrain his brain to overcome dystonia", Globe and Mail].
+The U.S. National Library of Medicine maintains a register of clinical trials of therapies to treat [https://classic.clinicaltrials.gov/ct2/results?cond=blepharospasm&term=&cntry=&state=&city=&dist= blepharospasm].
-* Federico Bitti, [https://www.youtube.com/watch?v=DwkHK3rfKO0 "Dystonia. Rewiring the brain through movement and dance", TEDxNapoli]
-* Joaquin Farias, [https://www.youtube.com/watch?v=czW-xBvDtHY "How your movements can heal your brain", TEDxNapoli]
-Blepharospasm Research Foundation
+==Multimedia==
+Blepharospasm Research Foundation
 * Victoria S. Pelak, [https://www.youtube.com/watch?v=gT6c_grVTRI Relationships of Blepharospasm to Ophthalmic Conditions such as Dry Eye], BEBRF Symposium, August 6, 2016.
-* Charles N.S. Soparkar, [https://www.youtube.com/watch?v=7b6dOoqhsl0 Blepharospasm and dry eyes], BEBRF Symposium, Sepember 9, 2017.
+* Charles N.S. Soparkar, [https://www.youtube.com/watch?v=7b6dOoqhsl0 Blepharospasm and dry eyes], BEBRF Symposium, September 9, 2017.
 * [https://www.youtube.com/watch?v=gLJPC30Ca9s Complementary/alternative therapies], Philadelphia, October 9, 2021
+Neuroplasticity training
-*
+* Federico Bitti, [https://www.youtube.com/watch?v=DwkHK3rfKO0 "Dystonia. Rewiring the brain through movement and dance", TEDxNapoli]
+* Joaquin Farias, [https://www.youtube.com/watch?v=czW-xBvDtHY "How your movements can heal your brain", TEDxNapoli]
 ==References==
 {{Reflist}}
@@ Line 100: / Line 99: @@
 * [https://eyewiki.aao.org/Blepharospasm American Academy of Ophthalmology: EyeWiki]
 * [https://blepharospasm.org/ Benign Essential Blepharospasm Research Foundation]
+* [https://classic.clinicaltrials.gov/ct2/results?cond=blepharospasm&term=&cntry=&state=&city=&dist= ClinicalTrials.gov]
 * [https://www.internetmedicin.se/neurologi/blefarospasm Internetmedicin <small>(Swedish source for licensed doctors)</small>]
 * [https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/blepharospasm National Eye Institute]

Classification	D ICD-10: G24.5 ICD-9-CM: 333.81 OMIM: 606798 MeSH: D001764 DiseasesDB: 15748
External resources	MedlinePlus: 000756 eMedicine: oph/202 Patient UK: Blepharospasm