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Bilateral blepharospasm as the presenting symptom of Sjögren's syndrome with evidence of central nervous system involvement

We present herein the case of a 58-year-old Caucasian woman who was admitted to the Neurological Department because of progressive difficulty in eyelid opening over the previous 3 months. Her past medical history was unremarkable except for high blood pressure, treated with angiotensin 2 receptor antagonist, as well as symptoms consistent with Raynaud phenomenon. However, upon questioning she admitted to have been having xerostomia for the last 3 years. Clinical examination revealed bilateral blepharospasm and was otherwise unremarkable. The ophthalmologic assessment defined no pathologic conditions that could contribute to or trigger significant eye irritation. Mild xerophthalmia – Schirmer’s test 5 mm,