Objective: To describe improvement in blepharospasm with apraclonidine.

Background: Blepharospasm is a focal dystonia involving chiefly the orbicularis oculi muscle resulting in involuntary sustained eyelid closure. Often preceded by an increase in blink rate and photosensitivity, blepharospasm may lead to social embarrassment, functional blindness, and dermatochalasis. The pathogenesis of blepharospasm is unknown but is thought to be due to dysfunction of the basal ganglia and related structures. Botulinum toxin (BoNT) injection is the mainstay of treatment with meaningful improvement in over 85% of patients, but the effects often wear off before the next treatment visit. Apraclonidine is a topical ophthalmic solution with α-2 adrenergic receptor agonist action, primarily used in glaucoma therapy, which causes contraction of smooth muscles in the eyelid with resultant widening of palpebral fissure. There are no published reports on the use of apraclonidine in blepharospasm, but we have made the observation that blepharospasm improve following the administration of apraclonidine. We propose that apraclonidine can be used to treat blepharospasm for transient symptom relief, particularly when BoNT effects wear off.

Methods: Patients who had pre-mature wearing off of BoNT effect or patients who were getting alternate treatment for blepharospasm were evaluated before and after the administration of 2 drops of apraclonidine 0.5%-1% solution to each eye. Subjective patient impressions were noted and examiner’s impression of symptoms pre and post-apraclonidine administration was recorded. A blinded rater evaluated the videos and provided an independent assessment of the severity of symptoms pre- and post-administration, using 0-4 scale (0 = no symptoms, 1 = slightly increased blinking, 3 = moderate, noticeable, eyelid spasms but not sustained, 4= definite, sustained eyelid spasms).

Results: Our study included 7 patients (4 male, 3 female) with a mean age of 61 years and mean duration of blepharospasm of 3.6 years. There was a subjective, albeit transient (about 2-4 hours), improvement in blepharospasm reported by all patients and by the examiner. The mean severity scores, based on blinded video ratings, showed a reduction from of 3.4 pre-administration to 2.3 post-administration of apraclonidine (p<0.025). No adverse effects were noted.

Conclusions: Apraclonidine is a potentially useful medication for short term management of blepharospasm while awaiting BoNT injection.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/apraclonidine-in-blepharospasm/