Treatment of blepharospasm in Tunisia: Expertise and exceptional results

What are the causes ?

The exact causes of blepharospasm are not fully understood, but it is generally thought to be a combination of genetic, environmental, and neurological factors. Here are some factors that can contribute to the development of blepharospasm:
Genetic Factors: Studies suggest that there is a genetic predisposition to blepharospasm. People with a family history of dystonic disorders, such as blepharospasm, have an increased risk of developing the condition.
Environmental factors: Certain environmental factors can trigger or worsen the symptoms of blepharospasm. This can include stress, fatigue, exposure to bright light, excessive use of computer or television screens, exposure to irritating chemicals or allergens.
Neurological dysfunction: Blepharospasm is considered a form of focal dystonia, which is a movement disorder characterized by contractions involuntary muscles. It is thought that abnormalities in the central nervous system, particularly in the basal ganglia, which regulate muscle movement, may contribute to the development of blepharospasm.
Other factors: Certain underlying medical conditions, such as Meige syndrome (a form of orofacial dystonia) or certain eye conditions, may be associated with blepharospasm. Additionally, long-term use of certain neuroleptic or antidepressant medications may increase the risk of developing eye spasms.

What are the symptoms ?

Blepharospasm is manifested by involuntary and repeated contractions of the muscles of the eyelid, which can lead to uncontrollable blinking and forced closing of the eyes. Symptoms of blepharospasm can vary in intensity and frequency, but typically include:
Forced eye blinking or closing.
Burning or stinging sensation in the eyes.
Sensitivity to light.
Eye strain.
Blurred or double vision.
Difficulty performing tasks that require fine vision, such as reading or driving.

How to diagnose ?

The diagnosis of blepharospasm is usually made by observation of symptoms by the doctor. However, tests can be carried out to help with the diagnosis, such as electromyography which measures the electrical activity of the muscles, or positron emission tomography. The doctor may also perform other tests to rule out other possible causes for the symptoms.

What are the treatment options ?

Treatment for blepharospasm aims to reduce involuntary muscle contractions and alleviate symptoms. Here are some common treatment options:
Botulinum toxin injections: Injections of botulinum toxin, such as botulinum toxin type A (eg, Botox ), are the most commonly used treatment for blepharospasm. Botulinum toxin is injected directly into the muscles responsible for the involuntary contractions of the eyelids. It temporarily blocks nerve signals that cause muscle contractions, thereby reducing symptoms. Botulinum toxin injections should be repeated regularly, usually every three to four months.
Oral medications: Certain oral medications may be prescribed to help reduce the muscle spasms associated with blepharospasm. Medications such as muscle relaxants, benzodiazepines, or dopamine antagonists can be used. However, their effectiveness may vary from person to person, and they may cause unwanted side effects.
Physical Therapy: Physical therapy can be used to teach muscle relaxation techniques, stretching exercises and reinforcement, as well as biofeedback techniques to help control eye spasms.
Sunglasses and environmental management techniques: Wearing sunglasses or using screens or filters to reduce environmental Exposure to bright light can help alleviate light-triggered symptoms of blepharospasm. Additionally, avoiding triggers such as stress, fatigue, and excessive screen use can help reduce the frequency of spasms.
Surgery: In severe cases that are resistant to other treatments, surgery may be considered an option. Surgery involves removing certain eyelid muscles or modifying their function to reduce involuntary contractions. However, surgery is usually used as a last resort when other treatments have not been effective.

What are the side effects of the treatments ?

Here are some potential side effects associated with common treatments:
Botulinum toxin injections: Botulinum toxin injections may cause temporary side effects, such as pain, bruising , redness or itching at the injection site. Temporary weaknesses in the surrounding muscles may also occur, which may cause temporary drooping of the eyelids or other ocular motor disorders. These side effects are usually mild and go away over time.
Oral medications: Oral medications prescribed for blepharospasm may have side effects such as drowsiness, dryness of the mouth, blurred vision, dizziness, gastrointestinal disturbances, coordination problems and mood swings. Each drug has its own side effect profiles, so it is important to discuss the specific risks and benefits of each drug with the doctor.
Physical therapy: Physical therapy itself usually has no significant side effects. However, stretching and strengthening exercises can sometimes cause temporary fatigue or mild muscle soreness.
Surgery: Surgery may carry inherent risks, such as bleeding, infection, allergic reactions to anesthesia or complications related to the procedure itself. Additionally, surgery can cause permanent changes in the motor skills of the eyelids, such as weakness, asymmetry, or a change in the appearance of the eyes.

How is the surgery performed ?

Surgery for blepharospasm is known as orbicularis muscle myectomy. Here is a general overview of the procedure:
Preparation: Prior to surgery, you will meet with your surgeon to discuss the procedure, your expectations, and potential risks. Preoperative exams, such as a complete eye exam, may be done to assess the condition of your eyes and the severity of your blepharospasm.
Anesthesia: Blepharospasm surgery can be performed under local or general anesthesia depending on patient preference and the surgeon's decision.
Incisions: The surgeon will make small incisions in the skin of the eyelids to access the orbicular muscles responsible for the involuntary contractions. The incisions are usually placed along the natural creases of the eyelids to minimize visible scarring.
Myectomy: Affected orbicularis muscles will be partially removed or weakened to reduce eye spasms. Different surgical techniques can be used, including partial muscle excision, tendon release, or muscle fiber resection. The technique chosen will depend on the severity of the blepharospasm and the preferences of the surgeon.
Closure: Once the myectomy is complete, the skin incisions are closed with fine sutures. Sterile dressings may be applied to the eyelids to promote healing.

How long does it take to recover ?

Recovery time after blepharospasm surgery can vary from person to person, and it depends on several factors, such as the extent of the surgery, individual reaction to the healing process, and overall health condition. Here is a general overview of the recovery process:
Immediately after surgery: After surgery, you will be monitored in a recovery room for a period of time to ensure as you recover from anesthesia. Your eyelids may be slightly swollen and you may feel discomfort or a feeling of tension. Your surgeon may prescribe pain medication or medication to reduce discomfort.
First days: The first few days after surgery, you will need to take care of your eyelids as instructed by your surgeon . This may include applying cold compresses to reduce swelling, using recommended eye drops, avoiding activities that could put pressure on your eyelids, such as wearing heavy glasses, and following rest guidelines. and recovery.
Following weeks: During the first few weeks after surgery, you will notice a gradual improvement in your symptoms of blepharospasm. The swelling and bruising should decrease, and you should gradually resume your normal daily activities. It is important to follow your surgeon's postoperative instructions, including the use of any recommended medications or treatments.
Full Recovery: Full recovery may take several weeks to a few months, depending on the nature of the surgery and individual reaction . Most patients see a significant improvement in their blepharospasm symptoms after surgery. However, mild residual contractions may persist in some patients, and additional treatment adjustments may be required.

What are the expected results ?

Expected results of blepharospasm surgery vary from person to person. Here are some general results you can expect:
Eye spasm reduction: Blepharospasm surgery aims to reduce involuntary muscle twitching of the eyelids. In most cases, patients see a significant improvement in their blepharospasm symptoms, with a reduction in the frequency and intensity of eye spasms.
Improved visual function: By reducing eyelid spasm, surgery can improve visual function by allowing patients to keep your eyes open more easily and longer. It can improve overall quality of life and make daily activities easier, such as reading, driving, and using screens.
Appearance improvement: Eye spasms can affect the appearance of the eyes and cause a tired or preoccupied appearance. Blepharospasm surgery can help improve the appearance of the eyelids by reducing involuntary twitching, which can have a positive impact on self-esteem.
It is important to note that surgery for blepharospasm may not completely eliminate eye spasms in all patients. Some patients may still experience light or sporadic contractions after surgery. In these cases, additional treatment adjustments, such as botulinum toxin injections, may be needed to optimize results.
Each patient is unique, and results may vary depending on extent of blepharospasm, individual reaction to surgery and other factors