WHAT IS BLEPHAROSPASM? UNDERSTANDING EYELID TWITCHING AND SPASMS

Medically Reviewed by Dr. Rosmy Barrios

Do you ever experience uncontrollable twitching or spasms in your eyelids? If so, you may be suffering from blepharospasm. This condition is often frustrating and uncomfortable, yet it is manageable with the latest advancements in treatment.

This article will explore blepharospasm, its causes, symptoms, and treatment options.

What is Blepharospasm?

Blepharospasm is a neurological condition that causes involuntary spasms or twitching of the eyelids (blepharo)^[1]. It can affect one or both eyes and range from mild to severe.

People with the condition may struggle to move their eyelids or maintain control over them when experiencing eyelid spasms. In some cases, the spasms can be so severe that they cause the eyelids to close entirely for hours, making it difficult to see.

According to the American Academy of Ophthalmology, the prevalence of blepharospasm is roughly 1.6 to 30 per 100,000 people. It affects females by a factor of 2-4 times more on average than males, with the onset often occurring between the ages of 40 and 60.

Types of Blepharospasm

There are two main types of blepharospasm: Benign Essential Blepharospasm (BEB) and Reflex Blepharospasm.

1. Benign Essential Blepharospasm (BEB): BEB is the most common type of blepharospasm, primarily proposed to be caused by a malfunction in the basal ganglia, a part of the brain that controls movement. This type is often associated with dystonia (muscle contraction disorder). It is more prevalent in women and typically develops in middle-aged or older individuals^[2].
2. Reflex Blepharospasm: Some conditions can cause the eyelids to twitch as a natural reflex in response to eye inflammation, dry eyes, factors that cause eye discomfort, or external stimuli, such as bright lights, wind, or eye irritation.

How Long Does Blepharospasm Last?

The duration of blepharospasm depends on the context and severity. In some cases, it may only last a few weeks, while it may be a chronic condition in others. With proper therapy, those affected can manage and control their symptoms.

Causes of Blepharospasm

The exact cause of blepharospasm remains unknown, yet it is likely to arise from a mixture of genetic and environmental factors.

The condition may trigger an excessive activation of the blink reflex, which leads to the contraction of several muscles around the eye and in the eyelid. These muscles connect to trigeminal nerve connections in the face and nose, leading back to the brain. Nerve communication issues at any point along the way may contribute to blepharospasm. Several studies report changes in brain networks that govern the blink reflex in patients with blepharospasm.^[3]

Gene mutations, such as those of DRD5 and TOR1A genes, may influence susceptibility to blepharospasm.^[4]

The condition occurs in those with Meige syndrome, Parkinsonism, dysautonomia, dry eye disease, tardive dyskinesia, dystonia, and Wilson disease.

Risk Factors

Some risk factors for developing blepharospasm include:

• Being over the age of 50
• Gender (more prevalent in females)
• Family history and genetics
• Previous eye injury
• Surgery, especially cataract surgery
• Specific medications, such as antipsychotics or anti-nausea drugs
• Reading, watching television, and computer screen use
• Stressful life events
• Fatigue
• Underlying eye disorders
• Psychiatric conditions, including depression, OCD, and anxiety

Other Reasons the Eyelids May Twitch

There are many reasons the eyelids may twitch temporarily that do not constitute blepharospasm, such as^[5]:

• Dehydration
• Extreme Tiredness
• Stress
• High caffeine intake
• Prolonged eye strain, dryness, or irritation
• Certain medications
• Allergic reactions

If you are experiencing symptoms of blepharospasm, it is essential to consult with a doctor for a proper diagnosis.

Symptoms of Blepharospasm

The main symptom of blepharospasm is involuntary twitching or spasms of the eyelids. These spasms fall on a spectrum from mild to severe and occur in one or both eyes.

In severe cases, other symptoms may include:

• Eye irritation or dryness
• Sensitivity to light
• Blurred vision
• Difficulty keeping the eyes open
• Headaches or facial pain
• Spasms in the eyebrow or other areas of the face

Some sources indicate that 40 to 60% of those with BEB present with eye dryness, grittiness, irritation, or burning before blepharospasm develops.^[6]

Individuals suffering from BEB may also have drooping eyebrows and eyelids, swollen or baggy eyes, inwardly turning eyelids, or abnormal tension in the muscles or structures around the eyes^[7].

Can Blepharospasm Affect Only One Eye?

While blepharospasm typically affects both eyes, it is possible for it only to affect one eye. It is essential to consult with a doctor for a proper diagnosis and treatment plan.

Complications

While blepharospasm is not life-threatening, it can significantly impact an individual's quality of life. The constant twitching and spasms are usually uncomfortable and can interfere with daily tasks. In severe cases, this condition can cause functional blindness due to the inability to keep the eyelids open.^[8]

Can Blepharospasm Be a Sign of a Brain Tumor?

In rare cases, blepharospasm can be a symptom of a brain tumor^[9] that influences a part of the brain governing eyelid muscle contractions. Yet the likelihood of this is very slim.

If you are experiencing other symptoms, such as headaches or changes in vision, it is advisable to consult a doctor for a thorough assessment.

Diagnosing Blepharospasm

There is no single test for blepharospasm, and the diagnosis is made through a clinical assessment and ruling out common causes. The doctor will check your symptoms and inquire about your medical history. They may also conduct a neurological exam to rule out other conditions.

In some cases, the doctor may acquire additional tests, such as an MRI or blood test, to rule out underlying possibilities.

Treatment Options for Blepharospasm

Although there is no cure for blepharospasm, there are a number of ways to control the symptoms and enhance quality of life. These include:

Botox Injections

Botox injections are the most common treatment for blepharospasm. It works as a neurotoxin that blocks nerve signals in or near eyelids that induce erratic muscle spasms. The injections are typically administered every three months and can provide significant relief from symptoms.^[10]

What are the side effects of Botox for eye twitches?

While Botox injections are generally safe, they can cause some side effects, including:

• Drooping eyelids
• Dry eyes
• Double vision
• Difficulty swallowing or speaking

Medication

In addition to Botox injections, your doctor may prescribe oral medications to help manage your symptoms. These may include muscle relaxants, anticonvulsants, or anticholinergics.

Myectomy

In severe cases of blepharospasm, a surgical procedure called a myectomy may be recommended.^[11] This involves removing some of the muscles responsible for the spasms in the eyelids. While this procedure can provide long-term relief, it is considered a last resort and is only recommended in severe cases or those resistant to Botox and medications.

Living with Blepharospasm

While blepharospasm can be frustrating and uncomfortable, it is possible to manage your symptoms and enhance your quality of life. These include:

Avoiding Triggers

It is important to recognize and stay away from triggers that can exacerbate your symptoms if you have reflex blepharospasm. These may consist of bright lights, wind, or eye irritation.

Additionally, patients with blepharospasm should not drive a vehicle as it may intensify their symptoms, which can lead to transient functional blindness that elevates their odds of having an accident.^[12]

Using Eye Drops

Using artificial tears or lubricating eye drops might help relieve dry eyes caused by blepharospasm.

Managing Stress

Stress and fatigue can worsen symptoms of blepharospasm. Using healthy management strategies, such as through exercise, meditation, or therapy, can help to lower stress and may lessen spasm frequency and intensity.

For those who feel self-conscious about their eyelid twitching, wearing glasses can be a helpful solution.

Physical Maneuvers

Some people find relief from performing the following actions due to the way they stimulate the nervous system:

• Pulling or pinching the eyelid
• Massaging the face and around the eyes
• Talking
• Yawning
• Humming
• Singing

Latest Advancements in Blepharospasm Treatment

As research continues, new advancements in blepharospasm treatment are being made.

One promising treatment is deep brain stimulation (DBS)^[13]. This process entails the surgical implantation of a device in the brain that delivers electrical impulses to the basal ganglia, helping to control muscle spasms. While DBS is still in the early stages of research, it has shown promising results in reducing symptoms of blepharospasm. Some studies reveal that it can also induce blepharospasm^[14]. More research is necessary to validate its efficacy.

Other areas of research pertain to better botox formulations, more effective neuromodulation techniques, and a better understanding of gene mutations that can contribute to the condition.^[15]

Conclusion

Blepharospasm is a neurological disorder involving uncontrollable twitching or spasming of the eyelids. Although there is no cure, there are a number of ways to manage symptoms and enhance quality of life. If you are experiencing blepharospasm symptoms, consult a doctor for a proper diagnosis and treatment plan. With the latest advancements in treatment, living with blepharospasm is manageable.

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