Answer:
Blepharospasm is involuntary eyelid closure resulting in significant visual disability. It may be caused by irritating eye diseases or be secondary to a neurological problem.
Treatment:
1) Conversion hysteria resolves in several weeks.
2) Medical treatment - Clonopin, Artane have 25% response rate. Tegretol - hepatic toxicity; Artane - urinary retention.
3) Surgery: partial facial neurectomy (temporal branch cut); stripping the lateral portion of the orbicularis; stripping orbicularis in pretarsal, preseptal and preorbital regions, lateral block of orbicularis muscle is removed down to periosteum; craniotomy with possibly doing something to facial nerve trunk.
4) Botulism toxin, a myoneural blocking agent that lasts 3-6 months; prevents the release of acetylcholine from presynaptic vesicles coupled with nerve impulse. It decreases the force of muscular contractions. It should be injected near the anterior lash line, taking care not to get the levator, lacrimal sac, or inferior oblique muscle.