Snapshot A 44-year-old woman presents to her primary care physician with persistent blinking. Initially, she felt an eye twitch, but now her eyes have been involiuntarily closing. She denies starting any new medications, and she is otherwise healthy. Physical examination demonstrates intermittent, involuntary eye closure. Introduction Overview focal dystonia involving the orbicularis oculi muscles other periocular muscles can be involved Epidemiology Incidence most commonly in 40-60 years of age Demographics female > male Pathophysiology Multifactorial process and unclear; however, it may involve a disregulation of a central control center for blinking Presentation Symptoms/physical exam typically bilateral involuntary spasms, leading to eye closure usually abates during sleep Differential Ptosis differentiating factor chronic eyelid drooping Meige syndrome differentiating factor blepharospasms are associated with oromandibular dystonia Treatment Medical botulinum toxin injection indication treatment of choice comments takes 2-3 days to have an effect with peak effect at 7-10 days reinjection is anticipated around 3-4 months Complications Functional blindness due to not being able to maintain the eyes open to perform activities of daily living Psychological stress Prognosis Most cases symptomatically improve with botulinum toxin injection