From the Guidelines
Blepharospasm, or eye twitching, is typically treated with botulinum neurotoxin, with OnaBoNT-A and incoBoNT-A being equally effective options 1. The causes of blepharospasm can be varied, but the treatment options are more straightforward.
- Lifestyle modifications such as reducing stress, getting adequate sleep, and limiting caffeine intake can help alleviate symptoms.
- In some cases, eye strain or dry eyes may contribute to blepharospasm, and using artificial tears or taking breaks from screens can provide relief.
- However, for persistent or severe cases, botulinum neurotoxin injections are often necessary.
- According to the American Family Physician guidelines, OnaBoNT-A and incoBoNT-A are equally effective and should be considered for treatment of blepharospasm 1.
- AboBoNT-A is also a possibly effective treatment option, although the evidence may not be as strong as for OnaBoNT-A and incoBoNT-A.
- It's essential to consult a healthcare provider if the twitching persists beyond a week, is accompanied by other facial spasms, affects both eyes, causes the eyelid to completely close, or is associated with vision changes or eye redness.
- In these cases, a proper diagnosis and treatment plan can be established, which may include botulinum neurotoxin injections to help manage the condition.
From the FDA Drug Label
- 9 Corneal Exposure and Ulceration in Patients Treated with BOTOX for Blepharospasm
Reduced blinking from injection of botulinum toxin products in or near the orbicularis oculi muscle can lead to corneal exposure, persistent corneal epithelial defect, and corneal ulceration, especially in patients with VII nerve disorders. Employ vigorous treatment of any corneal epithelial defect This may require protective drops, ointment, therapeutic soft contact lenses, or closure of the eye by patching or other means.
The cause of blepharospasm is not directly stated in the label, but onabotulinumtoxinA (IM) is used as a treatment for blepharospasm. The treatment for blepharospasm using onabotulinumtoxinA (IM) involves injection into the orbicularis oculi muscle, but it can lead to corneal exposure and ulceration. To manage these complications, vigorous treatment of any corneal epithelial defect is required, which may include protective drops, ointment, therapeutic soft contact lenses, or closure of the eye by patching or other means 2.
From the Research
Causes of Blepharospasm
- The exact cause of blepharospasm is not fully understood, but it is believed to be related to abnormal functioning of the brain's basal ganglia, which are responsible for controlling movement 3.
- Hemifacial spasm, a related condition, is often caused by vascular compression of the facial nerve 4.
Treatments for Blepharospasm
- Botulinum toxin is the primary treatment for blepharospasm, with a high success rate in reducing or eliminating symptoms [(3,5,6,7,4)].
- In cases where botulinum toxin is ineffective or poorly tolerated, oral medications such as trihexyphenidyl, baclofen, clonazepam, and tetrabenazine may be tried 3.
- Surgical options, including myectomy of the eyelid protractors or frontalis suspension of the eyelid, may be considered in severe cases where other treatments have failed 3.
Treatment Outcomes
- Studies have shown that botulinum toxin is effective in reducing symptoms of blepharospasm, with significant improvements in functional impairment and quality of life [(6,7)].
- The effective period of botulinum toxin injections can vary, but typically lasts for several months 6.
- Side effects of botulinum toxin injections are generally mild and temporary, including redness, hematoma, and facial weakness [(6,7)].