Eye dystonia (the medical term is Blepharospasm) is uncontrollable and often painful muscle contractions around the eye. Symptoms of eye dystonia may include excessive blinking and involuntary closure of the eyelids. The cause is believed to be incorrect messages from the brain to the muscles around the eye. Eye dystonia is a neurological movement disorder and should be diagnosed and treated by an ophthalmologist or a neurologist specialising in movement disorders.

Blepharospasm usually starts gradually. First symptoms may include eye irritation, sensitivity to light and increased blinking. The frequency and severity of the muscle spasms generally increases over a period of one to two years. Sometimes eye dystonia is experienced together with mouth, jaw or tongue dystonia (oromandibular). The medical term for this is Meige’s syndrome.

Causes:

The cause of dystonia is not fully understood. There appears to be a problem with the region of the brain called the basal ganglia. In most cases where dystonia appears in adults and some case where it appears in children, there is no clear explanation for why this problem arises.

However, in a minority of cases, the dystonia does have a clear cause. These are:

Another Medical condition

Where dystonias appear in children, in more than 80% of cases the dystonia will be secondary to another condition. In the majority of cases, this will be cerebral palsy.

Some dystonias appearing in adults may caused by stroke or tumour.

Drugs

Some dystonias, called Tardive, are caused by certain drugs (especially dopamine blocking drugs used to treat psychiatric disorders).

Genetics

Some cases generalised primary dystonia may be inherited.

 

Symptoms:

• Blinking and eyelid problems
• Neck problems
• Hand problems
• Voice problems
• Muscle spasms
• Tremor
• Dystonic Storms

Treatment usually involves regular injections, using a tiny needle, administered either by neurology or ophthalmology professionals and/or oral medication can also be prescribed. Some people find relief by applying light pressure to particular points on their face; symptoms can also be reduced by wearing dark glasses or wearing a hat with a peak. It is very much an individual experience.

Unfortunately there is not currently a cure. However, in the vast majority of cases, dystonia does not shorten a person’s life span. Most people do manage to develop successful strategies for living with dystonia combining treatment with pain control and sensory tricks.

Although there is currently no cure for dystonia, there are several widely used treatments. Many treatments are very successful but depend particularly on the type of dystonia and the age of onset. Because dystonia is such a complex and ‘individual’ condition, the usefulness of all these treatment options can vary widely between patients. Treatment regimes should be determined by a consultant familiar with dystonia.

Adult dystonia

The usual treatment regime for common forms of adult onset dystonia such as cervical dystonia, facial dystonia, oromandibular dystonia and blepharospasm is regular injections of botulinum toxin, which are usually repeated every three months.

Various oral medications drug treatments are available to assist in the management of some types of dystonia. However, not all medications are suitable for all people with dystonia.

In rare cases where cervical dystonia does not respond to botulinum toxin, Deep Brain Stimulation (DBS) brain surgery may be considered. Other surgical treatments which aim to either remove the problematic muscles or cut (denervate) selective peripheral nerves leading to these muscles, have also been found to be helpful for people with blepharospasm and torticollis respectfully.

Physiotherapy can be helpful to correct dystonic postures and movements in neck and hand dystonia. Speech and language therapy can be helpful if dystonia is affecting speech.

Young-onset dystonia

Many physicians will prescribe an initial trial of Levodopa for young patients as it can be highly effective in cases of dopa-responsive dystonia

Unfortunately, in the majority of cases, other oral drugs will be required of which Trihexyphenidyl is the most widely used. However, there are a number of other drug treatments available.

DBS brain surgery, especially in cases of generalised dystonia, can be of sustained benefit to certain young patients. Assessment will be required to determine whether DBS is suitable for individual cases. Botulinum toxin has limited use in the case of generalised dystonia as there are too many diverse muscles groups to treat successfully. It is used most successfully in the treatment of specific muscle groups.

Physiotherapy can be helpful to find the most effective way of coping with the dystonic movement. Speech and language therapy can be helpful if dystonia is affecting speech. An occupational therapist can help make adaptations to your approach to everyday life and make it easier to cope.

Acquired dystonia

Treatment of dystonia secondary to brain injury is often similar to that of young-onset dystonia. DBS is reported to be less successful in managing cases of secondary dystonia, as is botulinum toxin, although it can be useful when targeting specific small areas of muscle.

Physiotherapy can be helpful to find the most effective way of coping with the dystonic movement. Speech and language therapy can be helpful if dystonia is affecting speech. An occupational therapist can help make adaptations to your approach to everyday life and make it easier to cope.

For people with tardive dystonia (dystonia, which is a side effect to certain medications), the use of further medications to treat the symptoms of dystonia, needs to be managed very carefully.