Uncontrollable blinking eyes

Apr 21, 2003

HAVE you ever seen a person whose eyelids twitch quite often or blinks abnormally fast?

HAVE you ever seen a person whose eyelids twitch quite often or blinks abnormally fast? This abnormality is called blepharospasm and it has a variety of causes, ranging from dry eyes (conditions where tear flow is disrupted). It is a disease like any other and can be treated. It is called Tourette's syndrome, a neurological disorder of nerves.

Dr. John Lubega a medical doctor at Mulago Hospital says the disturbance is due solely to the forced closure of the eyelids. Blepharospasm, he says, usually begins gradually with excessive blinking and/or eye irritation. In the early stages it may only occur because of specific stressors, such as bright light, fatigue, and emotional tension. As the condition progresses, it occurs frequently during the day, even when nothing disturbs the eye.

“The spasms disappear in sleep, and some people find that after a good night's sleep, the spasms don't appear for several hours after waking up. Concentrating on a specific task may also reduce the frequency of the spasms. As the condition progresses, the spasms may intensify so that when they occur, the patient is functionally blind; and the eyelids may remain forcefully closed for several hours at a time,” he says.

Lubega says that blepharospasm is thought to be due to abnormal functioning of some nerves at the base of the brain, called basal ganglia. The basal ganglia play a role in all co-ordinated movements.

The doctor, however, says that in most people, blepharospasm develops spontaneously with no known precipitating factor, though it has been observed that the signs and symptoms of dry eye frequently precede and/or occur concomitantly with blepharospasm.
Infrequently, it may be a genetic disorder with more than one family member affected. “In some cases, spasms of the eyelids are accompanied by jaw clenching or mouth opening, grimacing, and tongue protrusion. Blepharospasm can be induced by drugs, such as the anti-parkinsonian drugs,” Lubega says.

Apart from medical treatment, there is need to manage stress because it makes all movement disorders, including blepharospasm, worse.
Some patients may benefit from a course for stress management from an occupational therapist. Dark glasses are the commonest aid because they reduce the intensity of sunlight, which bothers many people with blepharospasm, and they hide the eyes from curious onlookers.

Lubega says that drug therapy for blepharospasm is difficult as medications have generally produce unpredictable and short-lasting benefits. One drug may work for some patients and not for others. When the effects of one drug wear off, sometimes the replacement with another drug helps.

There is, therefore, no fixed or best drug. Establishing a satisfactory treatment scheme requires patience on the part of both the physician and the patient but the following drugs may be tried: artane, cogentin, valium and many others.

There is another option of surgery but before it is recommended, patients should try to medicines. Functionally impaired patients with blepharospasm who have not responded well to medication can be operated.

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