Is Benign Essential Blepharospasm a “Benign” and/or an “Essential” Condition?

Abstract

A study was conducted to find whether blepharospasm is a benign condition with no harmful effects to the health of a patient and to identify triggering factors causing it. A prospective, observational study was conducted at a tertiary referral center from April 2000 till March 2017. All cases referred for blepharospasm were included. After a detailed medical, social, ophthalmic, and family history, a thorough ophthalmic examination was conducted to find a primary as well as any secondary triggering factors causing blepharospasm. Assessment of functional disability was made subjectively by a Quality of Life questionnaire filled by the patient. History of acute triggering event causing anxiety or depression was present in 61 cases (96.8%). Secondary triggers causing blepharospasm were meibomian gland dysfunction in 100% cases, tear film instability in 96.8%, dry eyes in 85.71%, chronic Trachoma in 14.28%, concretions in 26.98%, trichiasis in 4.76%, and chronic blepharitis in 12.69%. At least 2 to 3 triggering factors were noted an all cases. An extreme visual and functional disability was present in all cases (100%). A thorough literature search pointed toward Basal Ganglia; a combination of primary and secondary triggering factors results in an overdrive of putamen area and its hypertrophy, causing blepharospasm. Blepharospasm produces severe physical and psychological disability in patients. It spreads to adjacent facial muscles. Therefore, it cannot be labeled a “benign” condition. Because a definite cause is responsible for triggering the blepharospasm and perpetuating it, it should not be considered an “essential” condition.