Focal dystonia is regarded as a characteristic feature of blepharospasm, but patients do not always present with these motor symptoms. The authors present a retrospective analysis of data from a large number of patients treated for drug-induced or essential blepharospasm at a large referral hospital in Japan. The aim of the study was to clarify the clinical features of blepharospasm in Japan. A total of 1116 patients presenting for a first visit and diagnosed with blepharospasm were included. Common symptoms included difficulty opening the eyes, photophobia and ocular pain / irritation. Initial symptoms often occurred following the long-term use of psychotropics (32% of patients). In the study, only 41% of patients received a diagnosis within one year of onset of symptoms. The findings demonstrate that the clinical presentation of blepharospasm is heterogenous, and that understanding regarding sensory-dominant forms of the disease may be poor among practitioners in Japan. Limitations of the study exist in that data was collected retrospectively and further studies would be required to fully clarify the clinical characteristics of blepharospasm, and hence develop specific diagnostic methods to enable early detection.