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Blepharospasm and Hemifacial Spasm

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Albert and Jakobiec's Principles and Practice of Ophthalmology

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Abstract

Blepharospasm and hemifacial spasm are the main facial muscle hyperactivity disorders seen in the ophthalmology clinic. They are characterized by stereotyped patterns of involuntary muscle twitching and are associated with functional blindness from eye closure, embarrassing disfigurement, and diminished quality of life. Blepharospasm, apraxia of eyelid opening, facial myokymia, eyelid myokymia, and their related syndromes are part of a family of focal facial dystonias. They are movement disorders distinct in pathophysiology and clinical presentation from hemifacial spasm. In both, diagnosis is clinical and further neuroimaging workup is warranted in atypical cases. Hemifacial spasm is most commonly caused by vascular compressive lesions at the facial nerve root exit zone of the brainstem, but it can also be mimicked by aberrant regeneration with synkinesis after an episode of Bell’s palsy. Treatment of facial muscle hyperactivity is largely symptomatic and temporary, primarily involving injections of botulinum toxin to weaken affected musculature, with a high short-term success rate in symptomatic control. In addition to chemodenervation, a variety of oral medications have been tried, and treatment of any associated neurologic disease is recommended. Particularly with refractory hemifacial spasm, neurosurgical intervention may be helpful.

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Authors and Affiliations

  1. Departments of Ophthalmology and Neurology, Veterans Administration Portland Health Care System and School of Medicine, Oregon Health & Science University, Portland, OR, USA

    Kimberly M. Winges

  2. Department of Surgery, Division of Ophthalmology, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

    Barbara Yates

Authors
  1. Kimberly M. Winges
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  2. Barbara Yates
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Correspondence to Kimberly M. Winges .

Editor information

Editors and Affiliations

  1. Casey Eye Institute, Oregon Health & Science, Portland, OR, USA

    Daniel M. Albert

  2. Department of Ophthalmology, Massachusetts Eye and Ear, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Joan W. Miller

  3. Department of Ophthalmology, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  4. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

Section Editor information

  1. School of Medicine, Oregon Health & Science University, Portland, OR, USA

    Eric Steele

  2. School of Medicine, Oregon Health & Science University, Portland, USA

    John Ng

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Winges, K.M., Yates, B. (2022). Blepharospasm and Hemifacial Spasm. In: Albert, D.M., Miller, J.W., Azar, D.T., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-42634-7_95

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  • DOI: https://doi.org/10.1007/978-3-030-42634-7_95

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