Understanding Blepharospasm (eyelid twitches)

The term Blepharospasm generally refers to eyelid twitches, spasms, or tics. It can be a common problem with many people, but can also have varying degrees of severity.

If it is persistent and severe, it can cause the eye to shut for extended periods, resulting in temporary vision problems, but it may also be a sign of a more serious nerve problem.

You may experience a twitch or spasm in either the top or bottom lid, and for the majority of people, the twitching will come and go multiple times throughout their lifetime as a result of a range of lifestyle factors. 

Types of Blepharospasm

Minor eyelid twitches

Eyelid twitches are often caused by an irritation of the cornea (surface of the eye) or the conjunctiva. More often than not, the cause cannot be fully identified, but the problem is painless and more of an annoyance than harmful. Minor eyelid twitches usually clear up in a few days. 

Benign Essential Blepharospasm (BEB)

This type of Blepharospasm tends to occur in mid/late adulthood, and can gradually worsen- it is not usually serious, but in more severe conditions, it can impact your daily life as spasms can cause the eyelid to close for extended periods of time.
It is believed that BEB can be caused by a combination of genetics and environmental factors, and it can be random too. The condition can be twice as likely to occur in women than in men. 

BEB can also be categorised as a focal dystonia, which is a neurological movement disorder.

Signs and symptoms

The signs and symptoms can vary between the conditions:

Minor Blepharospasm

• Eye twitching
• Uncontrollable blinking
• Uncontrollable eye spasms (minor)

Benign Essential Blepharospasm

• Spasms causing the eyelids to close shut 
• Chronic spasms/twitches
• Excessive blinking
• Persistent winking or squinting
• Light sensitivity
• Painful muscle contractions

What causes Blepharospasm?

There is a range of things that can cause Blepharospasm, it can be anything from stress to a sign of another eye condition, or in rarer cases, a brain or nerve disorder. Minor Blepharospasm can be associated with either lifestyle factors or a sign of an eye condition:

• Alcohol
• Caffeine
• Tobacco
• Fatigue
• Stress
• Eye Strain
• Blepharitis
• Dry eyes or allergies
• Light Sensitivity
• Conjunctivitis 

BEB common causes:

• The condition worsened by fatigue, eye irritation, stress
• Conjunctivitis 
• Eye disease or infection
• Eye injury
• Meningitis, or another central nervous system disorder
• Detached retina 
• Brain or nerve disorder (very rarely), such as Bell’s palsy, dystonia, Parkinson’s disease, or Tourette’s syndrome.

Some of these causes, such as meningitis, are considered medical emergencies and urgent care may be required.

If you have twitches or spasms in other facial muscles (especially around the mouth and limited to one side) as well as your eye, you may want to seek medical advice – this may be a Hemifacial Spasm.

How is Blepharospasm diagnosed? 

Because the condition is quite uncommon, it can be very difficult to diagnose Benign Essential Blepharospasm - the symptoms are often identified as alternative problems, and it can sometimes be misdiagnosed as eye strain/tired eyes, or dry eyes. However, if you are diagnosed with a different condition and the treatment doesn’t work, or symptoms do not clear up over time, it’s important to go back to your doctor or optometrist. 

Much of the diagnosis for Blepharospasm relies on ruling out other conditions or causes, looking at your medical history, and observing the characteristics of the spasm in a physical exam.

Further tests

If BEB is suspected, there may be a range of physical and neurological tests run to confirm the diagnosis.

How do you treat Blepharospasm? 

Most causes of eye twitches can be remedied with some changes to lifestyle or by treating the problem, such as conjunctivitis or using allergy eye drops. If you are tired, stressed, or taking in a lot of caffeine and alcohol, cutting these down or out of your diet and making some changes to your routine, might ease the spasms and/or get them to stop altogether. 

If the twitching continues over a longer period and becomes disruptive or serious, you will need to see a health care professional diagnose the cause and prescribe the correct course of treatment. 

Benign Essential Blepharospasm or Eye Dystonia 

There are a few treatments that can be used to help treat severe cases of Blepharospasm:

• Botulinum toxin injections (e.g. Botox or Xeomin) relieve the muscle contractions for a few months, stemming the twitching. It can also be recommended for those with hemifacial spasms. The injections would need to be repeated as necessary when the effects have worn off. 
• Medications such as anticholinergics, Baclofen and muscle relaxants may be used to help.
• Alternative treatments are sometimes suggested, however, the benefits are not supported by scientific studies. Therapies such as acupuncture, chiropractic, hypnosis, biofeedback, or nutrition therapy can be considered.
• Surgery may be considered if the other treatments are unsuccessful. These can include a myectomy, which involves some of the muscles and nerves of the eyelids being removed. For those with hemifacial spasms, a neurosurgical procedure might be undertaken to relieve the pressure of the artery of the facial nerve. Surgery results can be permanent, however, as with any surgery, they can lead to serious complications, and any side effects tend to also be permanent.