Benign Essential Blepharospasm Clinical Presentation

  • Author: Robert H Graham, MD; Chief Editor: Edsel Ing, MD, FRCSC  more...
Updated: May 16, 2016


At onset, there is increased frequency of blinking, particularly in response to a variety of common stimuli, including wind, air pollution, sunlight, noise, movements of the head or eyes, and in response to stress or the environment.[15, 16, 17, 18, 19] Patients may complain of photophobia and ocular surface discomfort, and especially of dry eye symptoms.[20] These symptoms progress over a variable period to include involuntary unilateral spasms, which later become bilateral.[21]

Patients may report that they are disabled to the point where they have stopped watching television, reading, driving, and/or walking. A family history positive for dystonia or blepharospasm further aids in the diagnosis.[22]

Blepharospasm commonly is associated with dystonic movements of other facial muscles. Anatomic changes associated with long-standing blepharospasm include eyelid and brow ptosis, dermatochalasis, entropion, and canthal tendon abnormalities.

  • The early symptoms of blepharospasm include increased blink rate (77%), eyelid spasms (66%), eye irritation (55%), midfacial or lower facial spasm (59%), brow spasm (24%), and eyelid tic (22%).
  • Symptoms commonly preceding diagnosis include tearing, eye irritation, photophobia, and vague ocular pain. While these complaints are common in the average ophthalmology practice, awareness of this disorder and proper suspicion may aid in early diagnosis.
  • Conditions relieving blepharospasm included sleep (75%), relaxation (55%), inferior gaze (27%), artificial tears (24%), traction on eyelids (22%), talking (22%), singing (20%), and humming (19%).
  • Comorbid diagnoses include dry eyes (49%) and other neurologic disease (8%). [23, 24]


In normal blinking, eyelid closure is the result of activity and co-inhibition of 2 groups of muscles, the protractors of the eyelids (ie, orbicularis oculi, corrugator superciliaris, procerus muscles) and the voluntary retractors of the eyelids (ie, levator palpebrae superioris, frontalis muscles). During the normal blink, the protractors and retractors have co-inhibition and function only at separate times. In patients with blepharospasm, this inhibition between the protractors and retractors is lost.



A specific etiology for blepharospasm has yet to be identified. Some patients with blepharospasm report a familial occurrence of the affliction. In families with autosomal dominant familial dystonia, affected members may have a generalized or segmental dystonia, while other members have various focal dystonias, such as isolated blepharospasm.

A study by DeFazio et al examined the first-degree relatives of 122 patients with primary blepharospasm. The study investigated genetic and environmental connections regarding the disorder and found no major difference between familial and sporadic cases with regard to coffee drinking and existing eye diseases. These findings suggest that sporadic and familial blepharospasm most likely has a commonality in etiologic background and influences of environmental factors.[25]

Wabbels has reported a single case of congenital blepharospasm.[26]

Zhou et al used functional MRI (fMRI) to identify abnormal neurological pathways in 9 patients with benign essential blepharospasm compared with controls.[27]

Contributor Information and Disclosures

Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, Arizona Ophthalmological Society, American Medical Association

Disclosure: Partner received salary from Medscape/WebMD for employment.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Hospital for Sick Children and Sunnybrook Hospital

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, Canadian Society of Oculoplastic Surgery, European Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Ontario Medical Association, Statistical Society of Canada, Chinese Canadian Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Ron W Pelton, MD, PhD Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, AO Foundation, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor, Stanley M Saulny, MD, to the development and writing of this article.

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