Blepharospasm: a review of 264 patients.

Abstract

Accepted 5 January 1988 in the information, the patient was contacted or seen again in the clinic to obtain the missing data.The mean age of onset was 55 8 (SD 12 5) years (range 11-81). There were 170 females (644%) and 94 males (35-6%). The female/male ratio was 1-8:1. Antecedent eventsThere was a psychiatric illness before or at onset of blepharospasm in 47 cases (17-8%). Twenty nine patients (11%) were depressed; two had a bipolar manic-depressive illness; 10 (3 8%) suffered an anxiety state; four were schizophrenic; two had a single unspecified psychotic episode. Fourteen of these cases (5-3% of the total series) were exposed to neuroleptics before the onset of their blepharospasm, so may have been examples of tardive dystonia. Thus, only 33 patients (13-2%) with non-tardive blepharospasm had a prior history of psychiatric disorder.Thirty two cases (12-1 %) had experienced local ocular disease in the year before the onset of their blepharospasm. In addition, a larger number of patients (55-3%) complained of ocular symptoms prior to or at the onset of their blepharospasm (table 1). However, only 13 patients (4 9%) developed new eye problems later during the course of their blepharospasm. The commonest complaints were of irritation, watering or grittiness of the eyes. Pain occurred in only 2 cases. Family historyA history of movement disorders in other first or second degree family members was given by 52 cases (19 7%). Relatives, either affected or unaffected, were not examined in this study (indeed many of them were already deceased).

Blepharospasm and hemifacial spasm: a protocol for titration of botulinum toxin dose to the individual patient and for the management of refractory cases

“…These figures compare favourably to other retrospective studies that report improvements in symptoms in 85-95% of patients. 2,3,5,20 Only eight patients stated that they were dissatisfied with the treatment, and a further 15 were lost to follow-up for unknown reasons during the 3-year period. Although 236 of patients (71.3%) experienced side effects at some stage during their treatment, the follow-up period was long (median 49 months), and the majority of these patients (137 patients) had a mild ptosis that did not interfere with the vision, or a mild lagophthalmos that did not require treatment.…”

“…2,3 With time, the phenomenon becomes more frequent until it causes difficulty with carrying out daily activities, and impairs health-related quality of life, causing social embarrassment, anxiety, and depression. [3][4][5] Rarely the spasm can cause functional blindness.…”

Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes

“…It is usually bilateral, although it may be unilateral briefly at onset. [1][2][3] Initial symptoms include unpleasant sensations, eyelid fluttering, and increased blink rate in response to stimuli, progressing eventually to chronic involuntary spasms in both eyes. 4 Quality of life may be significantly impaired, with increased difficulty in reading, writing, and driving.…”

Surgical approach to limiting skin contracture following protractor myectomy for essential blepharospasm

“…25 Complications of botulinum toxin injections are well documented and include ptosis, corneal exposure, lagophthalmos, symptomatic dry eye, lid malposition, epiphora, photophobia, diplopia, ecchymosis, and lower facial weakness. [24][25][26] In addition, BEB is associated with many eyelid deformities, including lid malposition, brow ptosis, dermatochalasis, blepharoptosis, and blepharophimosis, all of which may become more pronounced following botulinum toxin injections. 24 Furthermore, many patients are unwilling or unable to undergo long-term serial injections.…”