Which clinical history findings are characteristic of benign essential blepharospasm (BEB)?

Updated: May 20, 2019
  • Author: Robert H Graham, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Answer

At onset, blepharospasm is characterized by increased frequency of blinking, particularly in response to various common stimuli, including wind, air pollution, sunlight, noise, movements of the head or eyes, and in response to stress or the environment. [18, 19, 20, 21, 22] Patients may complain of photophobia and ocular surface discomfort, and especially of dry eye symptoms. [23] These symptoms progress over a variable period to include involuntary unilateral spasms, which later become bilateral. [24]

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. [25]

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%). [26, 27]


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