Blepharospasm as a masquerade of glaucomatous visual field defects.

PURPOSE: To present blepharospasm as a cause of glaucomatous-like visual field defects.

METHODS

We report a 72 year-old male with low-tension glaucoma who developed intermittent superior arcuate defects on Humphrey visual fields in one eye. Careful questioning and examination led to a diagnosis of blepharospasm (as part of hemifacial spasm), with secondary visual field changes.

RESULTS

MRI examination revealed no brainstem pathology or compression of the left 7th cranial nerve. The patient was referred to an oculoplastics specialist and received botox therapy in the upper and lower orbicularis oculi. Following treatment, there was stable resolution of superior arcuate changes on visual field testing.

CONCLUSIONS

Blepharospasm, whether in primary form as a central dystonia or secondary form from ocular surface irritation, may often go unnoticed by practitioners. Although a connection between essential blepharospasm and glaucoma development and progression has yet to be established, blepharospasm may yield glaucomatous-like changes on automated perimetry and should be considered in the same vein as other causes of spurious defects.