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A novel mechanism for benign essential blepharospasm.
J D McCann1, M Gauthier, R Morschbacher
1Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California at Los Angeles, 90095-7006, USA.
Ophthalmic Plastic and Reconstructive Surgery
|December 10, 1999
Summary
Photophobia in benign essential blepharospasm (BEB) may stem from sympathetically maintained pain. Cervical sympathetic blockade (CSB) provided relief for many BEB patients, suggesting a link between sympathetic nerves and ocular discomfort.
Area of Science:
- Ophthalmology
- Neurology
- Pain Medicine
Background:
- Benign essential blepharospasm (BEB) is a common neurological movement disorder.
- Photophobia is a frequent and debilitating symptom in BEB patients.
- The underlying cause of photophobia in BEB remains unclear.
Purpose of the Study:
- To investigate the hypothesis that photophobia in BEB is caused by sympathetically maintained pain.
- To explore the role of the sympathetic nervous system in BEB-associated photophobia.
Main Methods:
- An unblinded prospective treatment trial was conducted.
- Nineteen patients with photophobia and BEB underwent cervical sympathetic blockade (CSB) with local anesthetic.
- Outcomes included subjective reports of ocular symptoms and video analysis of eyelid movements.
Main Results:
- Thirteen of 19 patients reported subjective improvement in BEB symptoms following CSB.
- Objective evidence of reduced light-induced eyelid spasm was observed in 13 of 19 patients post-CSB.
- Ocular surface disease was identified in 18 of 19 patients.
Conclusions:
- The findings support the hypothesis of a sympathetically maintained pain syndrome in BEB patients.
- External ocular disease may contribute to this sympathetically maintained pain.
- Further research into the neurologic circuitry underlying these observations is warranted.