The Effect of Bangerter Occlusion Foils on Blepharospasm and Hemifacial Spasm in Occlusion-Positive and Occlusion-Negative Patients

Raman Malhotra*, 1, Siew-Yin Then1, Alison Richards1, Elizabeth Cheek2
Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK
School of Computing, Mathematical and Information Sciences, University of Brighton, Lewes road, Brighton BN2 4AT, UK

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© Malhotra et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Corneoplastic Unit, Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ, UK; Tel: 01342 414549; Fax: 01342 414106; E-mail:



To test the hypothesis that occlusion-positive (OP) patients with blepharospasm (BEB) or hemifacial spasm (HFS) will benefit from a Bangerter occlusion foil (BOF), compared to occlusion-negative (ON) patients. OP/ON was based on immediate improvement in spasm with placement of a hand in front of either eye.


Prospective non-randomised single-centre pilot study.


Fifteen-patients (6 BEB, 9 HFS).


Patients were identified as OP or ON and wore highest-density BOF tolerable over one spectacle lens for 1 month. Outcomes were assessed at 1 month.

Main Outcome Measures:

Validated quality-of-life questionnaire (CDQ-24), scores of blink-rate and spasm severity assessed by two observers from video-recordings.


OP group had mean improvement in all scores. There was no change or worsening of scores in the ON group. In both BEB and HFS, more OP patients reported subjective benefit from wearing a foil (2 of 4 BEB, and 2 of 2 HFS) compared to the ON group (0 of 2 BEB, and 1 of 7 HFS).


OP patients with BEB and HFS are more likely to experience improvement in spasms from wearing a BOF compared to ON patients. The occlusion test should be considered on all patients with BEB or HFS.

Keywords: Essential blepharospasm, bangerter occlusion foils, occlusion test.