Lid Wiper Epitheliopathy Present in All Patients With Blepharospasm, Hemifacial Spasm

Elderly female patient having an eye checkup
Close up portrait of a smiling serene blonde aged Caucasian woman undergoing a slit lamp examination
The condition is triggered by an increased coefficient of friction, according to investigators.

Lid wiper epitheliopathy appears to be present in all patients with blepharospasm or hemifacial spasm, or both, and an increased coefficient of friction appears to be the main pathophysiological mechanism that triggers it, according to research published in Archivos de la Sociedad Española de Oftalmología

The researchers conducted a prospective study to evaluate the presence of lid wiper epitheliopathy in patients with neurological diagnosis of essential blepharospasm, or hemifacial spasm, or both, before and 4 weeks after routine treatment with botulinum toxin. Before and after treatment, they assessed various ocular surface parameters in the cohort using the ocular surface disease index (OSDI) questionnaire, Schirmer test, tear break-up time (TBUT), Oxford test, and degree of involvement of the palpebral wiper.

A total of 31 eyes of 20 patients (mean age 54.8±5.8 years, 75% women and 25% men) with hemifacial spasm (9 eyes of 9 patients) and essential blepharospasm (22 eyes of 11 patients) were included in the study.

Both before and after botulinum toxin treatment, 100% of the patients had palpebral wiper involvement (lid wiper epitheliopathy score mean, 1.5±0.6 vs 0.7±0.3; P =.001; before: 30% mild and 70% moderate; after: 100% mild). OSDI was mild-normal in 75% of patients before treatment and 80% after treatment (ODSI score mean, 17.3±10.9 vs 15.2±8.6; P =.071). The TBUT was 7.2 ± 0.2 seconds before treatment and 7.5±0.7 seconds after treatment (P =.288). Schirmer’s test was 11.4 ± 5.5 millimeters before treatment and 12.5 ± 5.5 millimeters before treatment and after treatment (P =.578). The Oxford test findings were classified as pathological in 69.3% of patients before treatment and 54% of patients after treatment (Oxford stain score mean, 0.7±0.6 vs 0.5±0.5;  P =.008).

“Although this study presents short-term results (4 weeks after treatment) and accordingly the possibilities of conjunctival epithelium regeneration in such a short time are scarce, it reveals the importance of reducing the friction coefficient to improve the condition of the ocular surface in these patients,” according to the researchers. “It can be concluded that the most important pathophysiological mechanism in the production of wiper epitheliopathy in patients with blepharospasm or hemifacial spasm is the increase in the friction coefficient since, as in other studies, our results reveal a tear film of normal volume and quality.”

Limitations of the study included the short follow-up duration and relatively sample size. 


Romero-Caballero MD, Salmerón Ato MP, Palazón-Cabanes A, Caravaca-Alegría A. Lid wiper epitheliopathy in patients with blepharospasm and/or hemifacial spasm. Arch Soc Esp Oftalmol (Engl Ed). Published online March 12, 2022. doi:10.1016/j.oftale.2022.03.008