Blinking is healthy because the tear cleans the cornea and neutralizes microorganisms that could cause infections. But, in some cases, the act of opening and closing your eyes can characterize a disease, blepharospasm, whose main characteristic is to blink in an uncontrolled and excessive manner.

Benign essential blepharospasm is characterized by progressive involuntary spasms of the oculi orbicularis muscle and muscles of the upper face (corrugator and procerus). The forced and chronic contractions of the periocular muscles make the patient weak and lead to functional and cosmetic changes in the eyelids. Treatment includes a variety of oral modalities and medications that have limited effectiveness. Injections of botulinum toxin type A have shown good temporary results, while periocular myectomy has shown good results in the long term. As the disease progresses, the individual becomes removed from social life. Frustration and depression lead some to consider this disease as psychosomatic. However, the severity of blepharospasm is probably the cause and not the result of psychological changes.


Botulinum toxin type A is a neurotoxin that causes chemical denervation at the neuromuscular junction. The injection of botulinum toxin is a procedure that offers an effective therapy to control muscle spasms. After injections, the action is seen for 48 to 72 hours and the duration of symptomatic relief is 8-24 weeks. Not all patients respond to the injection of botulinum toxin.


The surgery is performed under local anesthesia with sedation and the upper and lower orbicularis, procerus and the eyebrow corrugator muscles are removed. Myectomy has improved visual impairment in a large number of cases. Sometimes the procedure has to be repeated. Complications of this surgery are the persistence of blepharospasm, hematoma, chronic lymphedema in the periorbital region (swelling) and anesthesia of the frontal region.

3 years after