Essential Blepharospasm

Benign essential blepharospasm (BEB) is a focal facial dystonia characterised by involuntary forced eyelids closure due to periorbital and facial muscle spasm. Over the last decades, the complex underlying mechanisms of this debilitating disease have begun to be elucidated, but many aspects of the pathophysiology and management remain unclear. A multidisciplinary approach is essential for the optimal management of BEB patients. Although both neurology and ophthalmology specialties are familiar with the use of botulinum toxins, neurologists have a central role in the assessment of dystonia and the use of systemic medications. Ophthalmology input should be always considered in order to fully assess the ocular surface and potentially provide surgical approaches to management. In this chapter we aim to highlight a summary of the up-to-date approaches to BEB and to give an overview of key aspects of the condition that require further understanding.