Blepharospasm
Possible Treatments: Botox and Rose-Tinted Glasses
By: Wissam Deeb, M.D. & Aparna Wagle Shukla, M.D.
Blepharospasm is the scientific name given to excessive involuntary forced eye blinking. It is one type of a large group of disorders called dystonias1. Dystonia is abnormal contraction/spasm of the muscles that result in abnormal posture or abnormal movement of a limb or joint. The most common form of dystonia is called cervical dystonia, it is a dystonia involving the neck muscles and usually presents with neck pain, abnormal head position and head shaking/tremor. Blepharospasm involves the eyelid muscles that cause inappropriate and excessive eye closure. It is one of the most common dystonia disorders, with 1500 to 2000 new patients diagnosed every year1. It affects women twice more than man and it is more common in the second half of life. In addition to being socially limiting because of the excessive blinking, it can make mundane activities such as reading or driving difficult. Sometimes the rate of blinking is too excessive that the patient is considered functionally blind1.
In addition to the increased and forced eye blinking, patients with blepharospasm have a myriad of other symptoms: dryness of the eyes, burning of the eyes, grittiness of the eyes, increased light sensitivity (sometimes light pain). Some patients report that a simple touch on the face or around the eye can decrease eye closure. This is called a sensory trick and is noted by almost 50% of all blepharospasm patients2.The mainstay of treatment of blepharospasm is the use of botulinum toxin (commonly known by one of its brand name – Botox)2. Botulinum toxin works by temporarily paralyzing the muscles injected. The injections for blepharospasm include the muscles around the eyelid and the eye (Figure 1).
Most studies show that the benefit from the injections starts within 1 week and lasts for at least 3 months. As the effect is temporary, injections need to be repeated and usually at a rate of one injection every 3 months. There are possible side effects of these injections if the weakness affected other muscles: eyelid droop (excessive weakness), blurred vision/double vision (weakness of eye movement muscles), worsening of dry eye feeling/increased tearing and foreign body sensation2.
Botulinum toxin injections can significantly decrease the rate of eye blinking and the forceful contractions. Unfortunately, they have limited to no effect on light sensitivity which can be very disabling. To address this symptom, many patients wear tinted glasses.
A first study3 compared the use of regular gray tinted sunglasses versus a rose-tinted lens called FL-41 in patients with blepharospasm (Figure 2). The rose tinted filters to improve light sensitivity, filtering out the green and blue parts of the light spectrum. Patients with blepharospasm are found to be more sensitive to these lights and thus blocking these wavelengths of light is desirable. This study showed similar benefit of wearing either type of glasses in decreasing the sensation of light sensitivity, though they report that the patients preferred to wear FL-41 rather than the regular gray tinted lenses. A second study4 with more “real life” light exposures showed a better control of all symptoms of blepharospasm such as light sensitivity and blink rate with the use of FL-41 compared to regular gray glasses. The FL refers to the fluorescent and has also been found to improve migraines too. In fact, FL-41 glasses were first studied three decades ago in England for patients with migraines who often complain of headaches triggered by exposure to bright lights. These rose-tinted filters can also be added to prescription glasses and tend to do better indoors than outdoors. The benign essential blepharospasm research foundation (BEBRF) lists FL-41 glasses as parts of their published hints for management of light sensitivity (http://www.blepharospasm.org/helpful-hints.pdf – this link also provides some other hints for management of blepharospasm symptoms). From our personal experience, many patients report improvement of their symptoms with the use of these FL-41 glasses and some who expressed their delight use it indoors as well as outdoors. FL-41 can be ordered through many resources, here are few examples:
Moran Eye Center Utah, 801-587-3765
Mr. Peabody’s Optical Shop in Boise, Idaho, 208-344-1390
Wolcott Optical in Salt Lake City, Utah, 801- 485-4474
Axonoptics online store, 779-379-2966 or www.axonoptics.com
References:
- Valls-Sole J, Defazio G. Blepharospasm: Update on Epidemiology, Clinical Aspects, and Pathophysiology. Front Neurol. 2016 Mar 31;7:45. doi:10.3389/fneur.2016.00045. Review. PubMed PMID: 27064462; PubMed Central PMCID: PMC4814756.
- Dashtipour K, Chen JJ, Frei K, Nahab F, Tagliati M. Systematic Literature Review of AbobotulinumtoxinA in Clinical Trials for Blepharospasm and Hemifacial Spasm. Tremor Other Hyperkinet Mov (N Y). 2015 Oct 30;5:338. doi: 10.7916/D8CJ8CVR. Review. PubMed PMID: 26566457; PubMed Central PMCID: PMC4636029.
- Adams WH, Digre KB, Patel BC, Anderson RL, Warner JE, Katz BJ. The evaluation of light sensitivity in benign essential blepharospasm. Am J Ophthalmol. 2006 Jul;142(1):82-87. PubMed PMID: 16815254.
- Blackburn MK, Lamb RD, Digre KB, Smith AG, Warner JE, McClane RW, Nandedkar SD, Langeberg WJ, Holubkov R, Katz BJ. FL-41 tint improves blink frequency, light sensitivity, and functional limitations in patients with benign essential blepharospasm. Ophthalmology. 2009 May;116(5):997-1001. doi: 10.1016/j.ophtha.2008.12.031. PubMed PMID: 19410958; PubMed Central PMCID: PMC2701948.