In a counsel of desperation Gerold1 in 1843 suggested treating intractable blepharospasm by "neglecting the spasm and carving a hole in the upper lid opposite the pupil through which the unfortunate patient could peep." Our mastery of this mysterious and dreadful affliction has not improved materially since Gerold's day.
Blepharospasm is an involuntary, persistent, and forcible contraction of the orbicularis muscle causing firm closure of the eye and lasting from a fraction of a second to hours. It has been classified in many ways. However, two main categories suffice for clinical purposes: (1) symptomatic, and (2) essential.
Symptomatic blepharospasm includes reflex spasm of the orbicularis due to corneal, conjunctival, and lid irritation as well as retinal stimulation due to bright light. A rarer subsidiary type is the tonic spasm of the orbicularis found in postencephalitic parkinsonism and similar affections.
Essential blepharospasm has no connection with the eye itself, and
FOX SA. Essential (Idiopathic) Blepharospasm. Arch Ophthalmol. 1966;76(3):318-321. doi:10.1001/archopht.1966.03850010320002