New trends in the treatment of blepharospasm: replacing the standardized approach with a personalized approach

Blepharospasm is a type of dystonia associated with overactivity of the orbicularis oculi and nearby muscles causing significant disability. Available treatments are only symptomatic, and many patients experience disability related to incomplete symptom relief. The authors provide a review the phenomenology of blepharospasm and its usual treatments. The evidence for botulinum toxin, oral pharmaceuticals and surgical treatments are summarized. Despite considerable phenotypic heterogeneity, the literature indicates a standardized approach to treatment is often pursued. PubMed was used as the primary source database for the literature reviewed relating to the treatment of blepharospasm published between April 1985 and May 2025. Although a standardized approach to treatment is common, a customized approach with attention to the particular combination of motor and non-motor symptoms occurring in individual patients improves therapeutic outcomes. The anatomical rationale and experience supporting a more personalized treatment strategy is emphasized. Also summarized are specific topics and strategies that are the subject of ongoing research to optimize the care of blepharospasm in the future.