Benign essential blepharospasm (BEB) research over the last 40 years has resulted in a range of new treatments from pharmaceuticals to surgical procedures. A new report in Current Opinions in Ophthalmology catalogues the various approaches to this irritating presentation. The condition involves involuntary spasms of the eyelid’s protractor muscles that are not caused by ocular surface disease. It may also be accompanied by photophobia and other sensory symptoms.

Since its FDA approval in 1989, botulinum toxin injection around the eyelid muscles has remained the go-to first-line therapy for BEB patients. However, three additional options have gained prominence lately. They include methylphenidate—an oral pharmaceutical adjunct therapy to botulinum toxin injections—dark-tinted lenses and myectomy. The research also suggests several classes of medications can be used to address these patients’ needs, including dopaminergics, GABA agonists and anticholinergics.

The darkened lenses (most reliably, FL-41 rose-colored lenses, according to the study) can ease the strain 79% of blepharospasm patients report from bright light. The study points to research showing the lenses, which were originally designed to ease migraine symptoms, can reduce blink rates in BEB patients, too.

When all else fails, the research says, myectomy can reduce spasm severity, increase the timeframe between botulinum injections and improve associated secondary eyelid and facial changes.

That irritating twitch and its associated symptoms may have no known cure, but in 30 years the development of a spectrum of treatment options has given BEB suffers a chance to regain some control.

Yen M. Developments in the treatment of benign essential blepharospasm. Curr Opin Ophthalmol. 2018 June. [Epub ahead of print].