Other muscles in the face or neck may be involved as well. The onset of blepharospasm is typically in the fifth to sixth decade and is more common in women than in men. The onset of essential blepharospasm usually is heralded by an increase in blinking or squinting with progression toward repetitive forceful closure and difficulty opening the eyelids. Blepharospasm is often made worse by stress, fatigue, bright lights, watching television or driving, and social interactions. Functional blindness in the presence of an otherwise normal visual system may result.
Systemic medications have limited efficacy in treating the disease.
However, some patients do benefit from such therapy alone or in conjunction with other treatment modalities. Essential blepharospasm is a diagnosis of exclusion. The course of the disorder can fluctuate. Spontaneous remissions and exacerbations are possible, but for most patients the disease is chronic. Dry eyes, in particular, may be the cause of eyelid spasm or can aggravate coexisting essential blepharospasm.