Treatment of Blepharospasm
Botulinum toxin type A injection is the definitive first-line treatment for blepharospasm, providing marked clinical improvement in approximately 93% of patients with effects lasting 10-20 weeks. 1
First-Line Treatment: Botulinum Toxin Type A
All three major formulations—OnabotulinumtoxinA (Botox), IncobotulinumtoxinA (Xeomin), and AbobotulinumtoxinA (Dysport)—are equally effective for treating blepharospasm. 1
The mean duration of improvement is 3.6 months, requiring repeat injections approximately every 10-20 weeks. 1
The safety profile is excellent, with an adverse effect frequency of only 3.0% overall, and all adverse effects being local, mild, and transient. 1
Botulinum toxin works by weakening the orbicularis oculi muscle to reduce involuntary lid spasms that can produce functional blindness. 2, 3
Clinical Context
Blepharospasm is a focal dystonia characterized by involuntary bilateral eyelid closure due to spasmodic contractions of the orbicularis oculi muscles. 4, 2
The condition is typically slowly progressive, predominant in females, and often appears in people older than 50 years. 2
At advanced stages, patients develop functional blindness and social withdrawal. 2
Second-Line Treatment: Surgical Intervention
Surgical procedures should be limited to the rare patients who do not respond to botulinum toxin treatment. 2
Anderson's method has proven to be an extremely successful permanent solution for severe cases of refractory blepharospasm, without long-term complications such as ectropion and lagophthalmos. 4
Surgery should only be considered after adequate trials of botulinum toxin therapy have failed. 4
Treatments to Avoid
Systemic and ocular medications have been recommended with poor results and should not be considered first-line therapy. 2
The effect size of botulinum toxin (90% of patients benefit) makes it unethical to withhold this treatment in favor of less effective alternatives. 5
Common Pitfalls
Do not confuse blepharospasm with blepharitis—these are entirely different conditions. Blepharospasm is a movement disorder requiring botulinum toxin, while blepharitis is an inflammatory eyelid condition requiring hygiene and antibiotics. 6, 7
Blepharospasm may be triggered by stress, fatigue, intense light, or individual factors—identifying and managing triggers can be helpful adjunctive therapy. 2
The condition is usually life-long and requires ongoing treatment with repeat botulinum toxin injections. 2