Blepharospasm is a movement disorder which that characterized by generally contraction of orbicularis oculi. The most common type is primary (idiopathic) subtypes though, common causes of secondary blepharospasm are structural brain lesions, neurodegenerative diseases such as parkinson's, tardive syndromes after use of drug, abnormal functioning of basal ganglia. Also it may be seen in the clinic with some psychiatric disorders, a side effect of antipsychotic drugs or as psychogenic blepharospasm. In thıs case we aimed to show that differential diagnosis of psychogenic blepharospasm in a patient using antipsychotic drug who diagnosed with schizophrenia.

Case: A 25 year-old male patient with paranoid schizophrenia who presented with difficulty opening his eyes for two years. For the previous 7 years he had been continuously treated with various antipsychotic drugs such as risperidone 4 mg/day, quetiapine 50 mg/ day, chlorpromazine 50 mg/day, sulpiride 100 mg/day. During this period, he has been hospitalized in psychiatry clinic because of acute psychosis. However, the patient did not use his drugs regularly and paid no attention about his control examination. Afterwards he presented to our clinic due to his challenging symptoms such as sudden irritability, hostility, suspiciousness, overpowering intense feeling that people are talking about him, looking at him, thinking people are working together to intend to harm him, social withdrawal. He diagnosed with paranoid schizophrenia and treated with paliperidone palmitate 150 mg. Also he was consulted to neurology clinic for his complaint of difficulty opening eyes and diagnosed with blepharospasm. MRG ve EEG tests were normal. The patient was treated with injection of botulinum. After the botulinum treatment his complaints recovered completely but the day after his complaints repeated immediately. Furhermore during the clinical observation complaints of closing his eyes have seen specially when he was bored and the doctors and nurses visit to him. In this case, early and acute onset, abnormal rapid response to treatment, especially emerging during the visit as factors that led us psychogenic blepharospasm.