Blepharospasm (BSP) is a restrictive dystonia characterized by excessive involuntary eye closure. Primary, idiopathic, and spontaneous blepharospasm are collectively referred to as benign idiopathic blepharospasm (BEB), and for patients with BEB, the ensuing anxiety and depression are more severe than the disease itself. Most patients have a bilateral onset, with some patients having a unilateral onset. Early manifestations include increased blinking, sunken eyelids, and often paroxysmal difficulty opening the eyes when gazing, exacerbated by stress and emotional distress, and relieved by talking, singing, chewing gum, relaxing, or touching a spot on the jaw. The eyelids may be closed and even become functionally blind. The disease can be combined with submandibular dystonia and progress to Meige’s syndrome or craniocervical dystonia. The etiology of BEB is not clear. BEB is not the result of a single dopamine receptor metabolic pathway disorder, but may be the result of a multifactorial dysfunction. Dystonia is caused by abnormal brain remodeling and the presence of loop inhibition in the motor areas of the patient. BABA-mediated increased striatal pallidum inhibition and decreased pallidum-thalamic inhibition cause a de-inhibited state in the ventral thalamus, resulting in increased cortical excitability and dysfunction. Electrophysiological studies in the patient’s middle prefrontal region revealed a shortened resting period in his facial muscles, indicating overexcitation of cortical neurons and a possible lack of inhibition of neurons innervating the facial muscles. Conventional imaging cannot detect structural and morphological abnormalities in the brain of BEB patients, and functional imaging methods are now mostly used to examine them. Positron emission tomography (PEP) shows that the cerebellum and cerebral bridge are hypermetabolic in awake BEB patients, while glucose metabolism in the striatum is reduced in the sleep state, and some scholars have used PEP to examine the thalamus of BEB patients and found that their metabolic activity is relatively active. Other scholars have found that the thalamus of BEB patients is hypermetabolic. Functional magnetic resonance imaging (fMRI) is currently a hot topic in brain function research, and the blood oxygen level-dependent (BOLD) effect can be used to obtain a functional activity map of the human brain, and the signal change characteristics of fMRI can be tracked at different spatial and temporal resolutions to dynamically study neural network activity and its anatomical sites. Using BOLD, scholars found significant activation in the middle thalamus and upper cerebellum of the primary motor cortex of the anterior cingulate cortex in BEB patients compared to controls. Using BOLD, scholars found activation in multiple visual areas of the cerebellum in frontal and parietal supplementary motor areas of primary sensory cortex in both BEB patients and normal subjects, but also in the shell nucleus of the nucleus accumbens in BEB patients. The clear activation-related areas of BEB may require the sequence and role of the activation areas recorded simultaneously by fMRI performed under myoelectric guidance to further clarify the relationship between abnormal muscle spasm and local brain function at different sites relationship of alterations. There are no studies proving the effectiveness of oral medications for BEB , and some suggest treatment with clonazepam, baclofen, and benzhexol. Botulinum toxin type A has been used as a first-line treatment for BEB for more than 20 years, and local injections can improve quality of life and reduce depressive symptoms in patients with BEB. botulinum toxin type A has a mean duration of efficacy of 3-4 months, with moderate to significant improvement in 90% of patients with BEB. Generalized weakness from small doses of botulinum toxin is uncommon, and long-term use of botulinum toxin preparations can lead to treatment resistance. The degree and frequency of blepharospasm is greater in female patients, but the difference in efficacy is not significantly different by gender, and finasteride (5 mg/d), a 5-&-reductase (5AR) inhibitor, has been reported to be effective in certain specific groups of botulinum toxin treatment-resistant BEB. Administration of a continuous low-frequency repetitive transcranial magnetic stimulation to cortical areas may reduce cortical excitability, thereby improving patient symptoms. In addition, facial nerve innervation by orbicularis oculi resection is a very effective treatment for BEB with a recurrence rate of 25%, but the procedure can be performed multiple times.