Tardive Blepharospasm Secondary to Chronic Antipsychotic Treatment: A Case Report

Blepharospasm secondary to antipsychotic use is a rare condition that impacts the patient's ability to perform most daily tasks.We want to present a case involving a 55-year-old Black man with a diagnosis of schizophrenia, with a history of first-and second-generation antipsychotic use, who also suffers from blepharospasm.He was admitted to an inpatient psychiatric unit after he was observed to have disorganization in speech and behavior, as well as grandiose delusions.While on the unit, blepharospasm impacted his ability to effectively participate, leading to questions about treatment.Historically, he received botulinum toxin for the treatment of blepharospasm with moderate effectiveness; however, administration of this medication was not available inpatient.On the unit, he was prescribed valbenazine; however, its effect was minimal, and, secondary to the patient's disorganization, the patient often refused.The patient continued to have significant debility, including visual field restriction, ambulatory difficulty, and trouble completing activities of daily living.He was eventually discharged with blepharospasm unresolved.We would like to highlight that anti-dopaminergic medications carry a not insignificant risk of debilitating physical effects.We would like to encourage providers to weigh the appropriate risks and benefits for treatment when choosing to start an anti-dopaminergic medication.