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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
  • Prognosis
    • most cases symptomatically improve with botulinum toxin injection
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

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