Blepharospasm is thought to be caused by a dysfunction within the basal ganglia (part of the brain responsible for controlling movement). The spasm may be triggered by psychological reasons such as stress, bereavement or grief, as well as physical factors such as dry and irritable eyes. There may be a hereditary role, as many individuals with this condition report a family history of a blepharospasm.

The uncontrolled or involuntary closure of eyelids or twitching is symptomatic in a number of other conditions. These include:

• Hemifacial spasm
• Meige syndrome
• Apraxia of eyelid opening
• Facial nerve palsy
• Synkinesis or aberrant regeneration
• Myokymia
• Parkinson’s disease
• Trigeminal neuralgia
• Tourette syndrome

Frequently, the cause of the blepharospasm can be established through a thorough clinical examination and medical history. Muscle function tests such as an electromyography (EMG) are sometimes carried out. In rare cases a neurological exam may be needed; this could include special sequence magnetic resonance imaging (MRI) or computed tomography (CT) scans.

Eye drops or systemic medications may sometimes be prescribed. These can be combined with massage treatment for certain pressure points around the eyes, which has been shown to help in some patients. For those experiencing light sensitivity (photophobia) eye drops and sunglasses may be recommended.

For those individuals experiencing blepharospasm triggered by a psychological reason such as stress or bereavement, understanding the diagnosis and possible causes is helpful. Mr Uddin works alongside established psychologists specialising in these areas.

An effective treatment for people with a moderate to severe blepharospasm is Botox therapy. Botulinum toxin (Botox) is injected to the muscles around the eyes, blocking signals from the nerves and effectively weakening the muscles, reducing and breaking the cycle of the spasm. It also reduces the discomfort and abnormal sensation associated with blepharospasm.

The procedure only takes a few minutes and involves injecting small quantities of botulinum toxin into various muscles around the eyes and face. Most patients experience a little discomfort, but the injections are usually not painful. The effects of the injection start to work within a few days.

Most patients may then need a repeat injection every 4-9 months to maintain the effect, with some needing it more frequently. A significant number of patients have only ever needed one injection.

Possible side effects to the Botox treatment include bruising and swelling, and rarely poor eye closure, a droopy upper eyelid and double vision. These are often temporary and wear off after one or two weeks. Although very unlikely, the Botox treatment can sometimes cause an allergic reaction.