Blepharospasm. Spasmodic contraction of the orbicularis oculi muscle causes excessive blinking and involuntary eye closure. It can often be accompanied by ocular foreign-body sensation and be ameliorated by distracting maneuvers, and is worse at rest or in bright light. There may be involuntary clonic eye closure, tonic narrowing of the palpebral fissure, or difficulty opening the eyes (eye-opening apraxia, p. 128). Blepharospasm may be so severe as to leave the patient no useful vision.
Oromandibular dystonia affects the perioral muscles and the muscles of mastication. In a condition named Meige syndrome blepharo-spasm is accompanied by dystonia of the tongue, larynx, pharynx, and neck. Cervical dystonia may involve head rotation (torticollis), head tilt to one side (laterocollis), or flexion or extension of the neck (anterocollis, retrocollis), often accompanied by tonic shoulder elevation or head tremor. It may be difficult to distinguish nondystonic from dystonic 64 head tremor; only the latter can be improved by antagonistic maneuvers. Dystonia often causes pain, usually in the neck and shoulder.
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