Like Dry Eye...But Not

This condition is so often diagnosed incorrectly as dry eye – but how can you tell the difference? Have you heard of blepharospasm? Maybe not… but you may have seen it in a patient and thought they were suffering from a common case of dry eye, and suggested some eye drops to help.

Dry eye syndrome is an ocular surface condition in which there is a decrease in the quality or quantity of tears, resulting in drying out of the ocular surface causing discomfort, visual disturbance, secondary tearing, or a foreign body sensation.

Meanwhile, blepharospasm involves the involuntary forcible closure of the eye by the eyelid muscles. It includes two types:

Primary blepharospasm — usually occurs without the symptoms of any other neurological or metabolic disease; considered to be caused by changes in the brain that have not yet been identified; this is the most common type of blepharospasm.
Secondary blepharospasm — attributed to an outside factor such as physical trauma, exposure to certain medications, or additional neurological or metabolic diseases; sometimes associated with brain lesions or drugs.

Blepharospasm may appear as frequent blinking, squinting of both eyes, spasms of eyelid closure, or simply difficulty in keeping the eyes open.

Certain disorders are often associated with, or mistaken for blepharospasm. In the case of dry eye, it is a frequent concomitant symptom with blepharospasm. Conversely, the side effects of dry eye can sometimes give the impression that blepharospasm is present when it is not. Photophobia (sensitivity to light) is a common ailment suffered by blepharospasm patients. Meige’s syndrome generally includes blepharospasm as part of the uncontrolled facial movements that define it. Apraxia of eyelid opening is sometimes present, and can complicate the diagnosis and treatment of blepharospasm.

How does blepharospasm affect quality of life?

Firstly and most importantly is the time it takes to diagnose blepharospasm. Dry eyes is the normal first diagnosis, whether it be from a GP, optometrist or pharmacist, and many eye drops are tried in an effort to relieve the condition. The patient gets very frustrated and your thoughts are that you are neurotic or have a psychological condition; in many cases it takes months – even years – to get the correct diagnosis.

What are the effects?

The spasms may increase in frequency and duration until a patient becomes functionally blind. Facial spasms may become more severe, interfering with speech or eating. The ability to drive, read and watch television, or perform other necessary daily activities can become increasingly difficult.

How can pharmacists help?

In many instances, when people present with irritated eyes, the pharmacy is the first “port of call”. If a pharmacist or a pharmacy assistant recognised that the constant blinking, forced closure, squinting and irritation to lighting is more than dry eyes, he/she could then suggest further investigation by a medical professional.

The diagnosis of blepharospasm is not easy; for many people it has taken years of being told they have dry eyes and copious amounts of various eye drops which may relieve the dry eye but does not fix the BIG problem.

Neurologists and ophthalmologists are generally aware of the condition; to see one of these specialists you must have a referral from a general practitioner and this is not always easy as, again, in many cases the early diagnosis is dry eye and another prescription to take to your pharmacy.

Optometrists also in most cases diagnose dry eye, some may have heard of blepharospasm, but most do not recognise the symptoms. 

What are some things people can do to relieve the symptoms?

• Wear sunglasses (type that wrap around to cut wind and glare)
• Wear a hat with a brim
• Sit facing away from windows
• Wear tinted lenses
• Place warm or cold compresses on the eyes
• Use sensory tricks
• Concentrate on a hobby or non-stressful activity
• Talk, sing or humTouch temple or forehead

Refresh your knowledge on dry eye; the symptoms and treatment strategies with the education modules below. Click here for more information on blepharospasm.

Source: ajp.com.au/features/health-focus/like-dry-eyes-but-not/?utm_source=AJP+Daily&utm_campaign=4e3337db4d-EMAIL_CAMPAIGN_2017_07_27&utm_medium=email&utm_term=0_cce9c58212-4e3337db4d-109985429, viewed 28 July 2017