Botulinum toxin (Botox) treatment for blepharospasm

Information for patients from Ophthalmology

This leaflet is not meant to replace the information discussed between you and your doctor, but can act as a starting point for such a discussion or as a useful reminder of the key points.

Blepharospasm is a condition that affects how your eyes blink. Patients with this condition often have involuntary clenching of the muscles that control their eyelid, causing uncontrollable blinking which generally affects both eyes.

Blepharospasm can cause problems for patients when they try to do everyday activities. It can interfere with their ability to see, as their eyelid blocks their eyes. Although the condition is not fatal, it can badly affect a person’s quality of life.

What is blepharospasm?

‘Blepharo’ means eyes. A spasm is a sudden involuntary contraction of a muscle or a group of muscles. An increase in how often the eyelid closes and its tone is known as blepharospasm.

The normal adult blinks 10 to 20 times per minute; it tends to be less when reading or using a computer. This lasts for varying amounts of time, from seconds to minutes and often repeatedly.

Symptoms range from an increased blink rate with occasional spasms to a severe, disabling, and painful condition.

How common is it?

Blepharospasm is a rare condition. The condition is thought to affect around one in 10,000 people. It affects both men and women, although women tend to be affected slightly more often than men. It is more common in older age, but symptoms usually start in middle age.

What causes it?

The cause of blepharospasm is not fully understood. Doctors believe the main cause is pressure on the facial nerve from a structure or abnormality in the brain. The most common finding is a blood vessel at the base of the brain pressing on the nerve. There are other rare causes too, such as infections or strokes.

Sometimes there is no obvious cause and doctors may then call it idiopathic (of unknown cause) blepharospasm.

Is it inherited?

No. It is unlikely that you will pass the condition on to your children.

What are the symptoms of blepharospasm?

Some people may have a mild condition that causes inconvenience and embarrassment. Others find the spasms may affect their vision.

For some people the spasms may become worse when they are tired and stressed. They may also improve when they lie down

How will Botox injections help?

Although there is no guaranteed cure, you may be offered injections around your eye to help treat your condition.

Botulinum can be used in controlled doses, to safely relax excessive muscle contraction. It is injected into the muscles and blocks the signal from the nerve, which helps to stop the spasms. The effects of the injection last for two to three months and it starts to work within a few days. About seven out of 10 people with blepharospasm are helped by botulinum (Botox) injections.

Do the injections hurt?

The injections are not generally painful, but you may feel some discomfort that should only last a few seconds.

What are the side effects to Botox?

There can be some side effects of the injection. These are commonly bruising, drooping of the eyelid, and double vision. They usually wear off after one or two weeks.

What is the outlook?

Blepharospasm is usually a long-term condition. It is not fatal but may affect your quality of life. It very rarely improves completely without treatment.

Are there any alternative treatments for blepharospasm?

Yes. In some cases drug treatment can be helpful when the spasms are mild or infrequent. Prescribed anti-epileptic medicines can be helpful in some people with blepharospasm. These medicines work by reducing nerve impulses. Other medicines which can be used to treat the condition are sedatives; these can relax muscle spasms but they may also make you feel sleepy.

The response to these medicines can vary and it may take time to get your dosage sorted. They will need to be taken on a long-term basis.

There are some surgical procedures that can be done but they are often unsuitable for many patients with blepharospasm. There are some serious side effects that may occur as a result of surgery, and so it is usually only used as a last resort.

Is there anything I can do to help myself?

Learning relaxation techniques may help some people who have blepharospasm. Educating yourself about your condition and staying positive can also help. Complementary therapies such as homeopathy or acupuncture do not seem to help this condition.

Further information

What if I have any questions or concerns?

If you have any further questions or feel unwell after your procedure, please contact the ophthalmology matron using the mobile number given to you at your appointment. Or you can call Rotary Ward at William Harvey Hospital on 01233 616261 and ask for the doctor on-call.