A 64-year-old woman presents with a complaint of abnormal eyelid closure, which has been getting worse over the past 2 years. She describes recurrent, episodic, and involuntary closure of both eyelids, resulting in discomfort, and feels unsafe undertaking tasks such as driving; she is also experiencing distress about her appearance in social settings. Clinical examination reveals normal visual acuity, pupil reactivity, and eye movement. A photograph of the patient during an episode is presented above.
The most likely diagnosis is
Keratoconjunctivitis sicca
Facial myokymia
Benign essential blepharospasm
Hemifacial spasm
Answer on page 1155