What Is an Eyelid Spasm?
The three most common types of eyelid spasms are eyelid twitch, essential blepharospasm, and hemifacial spasm.
- Eyelid Twitch
Typically a unilateral slight spasm of your lower or upper eyelid, or occasionally both eyelids, is common, of no concern, and usually resolves in a few days. This can be associated with lack of sleep, stress, or excess caffeine.
- Essential Blepharospasm
An involuntary condition involving both eyes which starts as an increased blink rate and eventually leads to closing of the eyelids as well as squeezing of the muscles around the eyes. In some cases of essential blepharospasm, muscles of the mouth or neck also are involved. When these spasms occur, the involuntary eyelid closure may cause a temporary inability to see. Essential blepharospasm is rare but very troublesome and often incapacitating.
- Hemifacial Spasm
A condition that involves involuntary closure of the eye along with muscles in the cheek, mouth, and neck, but on only one side of the face.
- Twitching or spasm around the eyes
- Facial spasms
The symptoms described above may not necessarily mean that you have eyelid spasms. However, if you experience one or more of these symptoms, contact your ophthalmologist for a complete exam.
- The cause of minor eyelid twitch is unknown.
- The essential blepharospasm is a focal dystonia, or abnormal movement, produced by the part of the brain controlling movement. The cause of essential blepharospasm is almost never a psychiatric disease.
- The cause of hemifacial spasm is thought to be an abnormality in the nerve to the facial muscles, which causes the face to twitch.
Essential blepharospasm usually occurs more commonly in females and at a later age.
Tests and Diagnosis
These conditions are distinguished by a careful clinical examination. Rarely, hemifacial spasm is caused by a tumor pressing on the facial nerve, found with MRI testing.
Treatment and Drugs
- Eyelid Twitch
Minor eyelid twitches require no treatment as they usually resolve spontaneously. Reducing stress, using warm soaks, correction of any refractive error, and lubrication of the eye with artificial tears may help. Some ophthalmologists recommend reducing caffeine usage.
Blepharospasm can be treated with medications, biofeedback, injection of botulinum toxin, and surgery. Medications and biofeedback are rarely successful in managing blepharospasm. Botulinum toxin injections are now the most commonly recommended treatment for blepharospasm. Injection of botulinum toxin in very small quantities into the muscles around the eyes will stop the spasm. The injection works for several months but will slowly wear off and usually needs to be repeated 3 to 4 times each year. The treatment is very successful with few side effects. On rare occasions when side effects occur, they include drooping of the eyelids or double vision. Side effects typically last 1 to 2 weeks while the good effects last 3 months. Surgery to remove the involved muscles is occasionally needed in addition to botulinum toxin therapy.
- Hemifacial Spasm
Botulinum toxin injections can relieve the eyelid and facial spasms in patients with hemifacial spasm. A neurosurgical procedure for hemifacial spasm, microvascular decompression, also can relieve the facial spasms. While it is generally successful, it is a major neurosurgical operation and serious complications are possible.
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Reviewed by Wayne T. Cornblath, M.D.