Benign essential blepharospasm is a focal cranial dystonia characterized by involuntary, symmetrical eyelid closure seen most often in middle-aged to older individuals in the sixth to seventh decades of life. It is considered to be a defect in the central neurological circuit that controls eyelid muscle activity and coordination. Symptoms range from increased frequency of blinking to sustained forceful, sometimes painful, squeezing of the eyelids that can lead to functional blindness. In many cases, the spasm may be localized to the eyelid protractor muscles but with progression, spasms may spread to adjacent areas of the head and neck. Patients often have to hold there eyelids open in order to see. Over the past four decades, botulinum toxin injections for chemodenervation of the eyelid closing muscles has become the treatment of choice.