Abstract
We evaluated whether the pupillary light reflex is altered in benign essential blepharospasm patients. Twenty-three patients with benign essential blepharospasm, 47 with reflex blepharospasm, and 29 dry eye disease controls were included. Pupillary light reflex-related parameters were measured under mesopic (10 lux) and photopic illuminance (200 lux) using an infrared pupillometer. Additionally, we assessed photophobia grade, eyelid function, and dry eye disease-related parameters. There were no differences in age, sex predominance, or dry eye disease-related parameters among the three groups, or in photophobia grade and eyelid function between benign essential blepharospasm and reflex groups. Constriction velocity and maximum constriction velocity in the mesopic condition were significantly greater in the benign essential blepharospasm group (3.26 ± 0.56 and 5.27 ± 0.90 mm/s) than in reflex (2.86 ± 0.62 and 4.59 ± 1.00 mm/s) or dry eye disease groups (2.96 ± 0.46 and 4.72 ± 0.67 mm/s). Constriction velocity and maximum constriction velocity in the mesopic condition positively correlated with photophobia grade (r = 0.525 and 0.617, P = 0.025 and 0.006) in the benign essential blepharospasm group. Pupillary light reflex may be related to the pathophysiology of benign essential blepharospasm with photophobia. Further studies are required to reveal connections among pupillary light reflex, photophobia, and focal dystonia in benign essential blepharospasm patients with photophobia.
Highlights
Benign Essential Blepharospasm (BEB) is a form of focal dystonia that manifests as involuntary bilateral contraction or spasm of the eyelids without neurological causes
There were no differences in age and sex predominance among the BEB, reflex, and dry eye disease (DED) groups; all patients of the BEB and reflex groups exhibited photophobia and dry eye symptoms (Table 1)
There were no differences in eyelid functions or photophobia grade between the BEB and reflex groups, whereas, of the DED-related parameters, only ocular surface disease index (OSDI) score showed a significant difference among the three groups (Table 2)
Summary
Benign Essential Blepharospasm (BEB) is a form of focal dystonia that manifests as involuntary bilateral contraction or spasm of the eyelids without neurological causes. It is predominant in females and mostly affects people over 50 years old.[1] Starting with mild twitches, it usually progresses to excessive blinking, forceful bilateral spasm of eyelids, and in advanced cases, to involuntary eye closure or functional blindness.[2] Its etiologies are unclear and multifactorial. BEB is clinically diagnosed by exclusion diagnosis and must be distinguished from secondary blepharospasm, which can occur in association with underlying neurologic diseases, or a specific ocular disease such as in reflex blepharospasm secondary to ocular irritation.[3] Research
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