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Blepharospasm is defined as an involuntary eye closure, triggered in particular by bright light, watching television or driving a car.

Major visual difficulties, in particular outdoors when walking and driving, can confine the patients indoors. Initially patients can complain of dry or sore eyes. Some patients have a spasm of the upper eyelid only, and have major difficulty reopening their eyes. This is a variant of blepharospam called “apraxia of eyelid opening”.

Blepharospasm belongs to a large group of neurological condition known as dystonia. The age of onset is around 60 years; the cause of dystonia is still not fully understood, but it’s likely to be genetically determined with a low penetrance of the gene.


The most efficient treatment of blepharospam is Botulinum toxin injections, which have been routinely performed for this condition since 1986.

The patient can be injected following consultation on their first visit. The protocol of injection (doses, number of injections) will be decided based on the clinical examination. The injections can be directed into the different portions of the orbicular is oculi, depending of the type of spasm.

Orbicularis oculi muscle & Pretarsal injections
1-orbital portion
2-preseptal portion
3-pretarsal portion

The injections are performed with the patient lying down. The effect starts 3 to 5 days after the injections. The full effect is seen 1 week after the injections and usually last 3 months .The patient is invited to come back 3 to 4 weeks after the initial injections for a free consultation to check if the result is satisfactory. Eighty per cent of blepharospasm patients respond very well to standard treatment.

Most of the patients who do not respond to the injections present with an apraxia of lid opening and complain of difficulty in opening their eyes. This type of blepharospasm respond well to injections of BTX into the pretarsal portion, along the eyelashes.


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