Developments in the Treatment of Benign Essential Blepharospasm

Michael T. Yen


Curr Opin Ophthalmol. 2018;29(5):440-444. 

In This Article

Abstract and Introduction


Purpose of review: To review new developments in the medical and surgical treatment options for benign essential blepharospasm (BEB).

Recent findings: Botulinum toxin injections remain the mainstay treatment for BEB with several formulations currently commercially available. Reports in the medical literature support photochromatic modulation for the symptoms of photophobia, as well as oral medications and surgical myectomy for control of the motor signs of eyelid protractor spasm.

Summary: Although there remains no cure for BEB, several treatment options are available to effectively manage the signs and symptoms of the condition.


First reported in the Western medical literature in 1857, benign essential blepharospasm (BEB) is a disorder of involuntary spasms involving the eyelid protractor muscles.[1] Affecting approximately 1.4–13.3 cases per 100 000, it is a distressing and disabling disorder, with women more commonly afflicted than men (3 : 1).[2,3] It usually begins with increased eyelid blinking episodes, and whereas the course is variable, many cases progress and can eventually lead to spasms so severe that they leave the patients functionally blind. BEB has been noted to have certain precipitating factors such as driving, reading, stress, bright lights, and many other factors; the condition can sometimes be alleviated by singing, humming, walking, talking, and relaxation, and in some patients, applying pressure to 'trigger points' may alleviate an attack of blepharospasm. The condition has also been associated with severe photophobia which may persist even after effective control of the motor spasms.[4]

When evaluating patients for BEB, it is important to rule out reflex (secondary) blepharospasm as the cause, as this is the most common cause of eyelid spasms and is usually due to ocular surface disease. Management of the underlying ocular surface conditions is typically effective for managing these cases of secondary blepharospasm. In some cases of secondary blepharospasm, botulinum toxin injections may also be a useful adjunct treatment.[5] Although the underlying cause of BEB remains unknown, treatment options for BEB have advanced significantly over the past 40 years. Although no cure currently exists, many of the currently available treatments, or combination of treatments, can be very effective in managing the signs and symptoms of BEB. Several treatment options are available including photochromatic modulation, oral pharmacotherapy, botulinum toxin injections, and surgical treatment.