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
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Keratoconjunctivitis sicca
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Facial myokymia
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Benign essential blepharospasm
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Hemifacial spasm
Answer on page 1155
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