Blepharospasm: causes, treatment and outlook

Blepharospasm is the medical name for a twitching eyelid. The name comes from the words ‘blepharal’, which means linked to the eyelid, and ‘spasm’, which is an involuntary muscle contraction.

Doctors divide blepharospasm into two types: primary and secondary. Primary blepharospasm is not associated with another underlying health condition. Secondary blepharospasm occurs when another health condition causes it.

Most cases of blepharospasm are secondary and go away on their own. Causes are usually minor and include:

  • lack of sleep
  • too much caffeine
  • strenuous exercise

Benign essential blepharospasm is a rare progressive neurological condition that affects approximately 20 to 133 people per million worldwide.

It causes progressively worse eye twitches in both eyes. The severity varies greatly from person to person. It can be mild or severe enough to affect a person’s quality of life.

This article will focus on benign essential blepharospasm.

Learn more about general eye twitching.

Benign essential blepharospasm is part of a group of movement disorders called dystonia. Dystonia is characterized by involuntary muscle contractions.

Experts do not fully understand the cause of benign essential blepharospasm.

Genetic mutations may play a role, as approximately 20% to 30% of people with benign essential blepharospasm have a family history of people with the condition.

Other factors that may play a role include:

  • dysregulation of neurotransmitters
  • structural damage
  • facial trauma
  • previous eye disorders
  • other neurological movement conditions such as Parkinson’s disease

Medicines that treat Parkinson’s disease can also cause blepharospasm.

Women develop benign essential blepharospasm about 3 times more often than men. It most often develops between the ages 50 and 70with an average age of 56.

Inherited genes that scientists believe play a role in its development include:

According research 2022other factors with a potential link to benign essential blepharospasm include:

  • live in an urban environment
  • working a “white collar” job associated with a stressful lifestyle
  • read frequently or stare at a screen

The same research from 2022 notes that about 40-60% of people have eye symptoms that occur before the onset of blepharospasm.

These eye symptoms include:

Certain mental health conditions appear to be linked to a higher risk of blepharospasm. They understand:

Benign essential blepharospasm almost always affects both eyes, according to the National Organization for Rare Disorders.

Spasms usually occur during the day and disappear at night during sleep. They can also temporarily disappear during activities such as:

  • singing
  • laughing
  • chewing
  • yawn

The early stages of the disease are usually characterized by an increased rate of blinking aggravated by stimuli such as:

  • Sparkling light
  • fatigue
  • emotional stress
  • wind and pollution

It may become more difficult to keep your eyes open over time as the disease progresses.

The severity of symptoms varies greatly from person to person, depending on research 2022. In severe cases, your eyelids may be closed for hours. It can cause functional blindness, although there is no actual structural damage to the eye or the visual centers of the brain.

Spasms can spread to the lower face, mouth or jaw. When this happens, it is called Meige syndrome. This can cause symptoms such as:

  • clenched jaw
  • grimacing
  • tongue protrusion

When to Seek Medical Help

The national eye institute recommends seeing a doctor if:

  • Your eyelids are twitching for more than two weeks.
  • Your eyelids close completely when they contract.
  • You develop contractions in other parts of your face.

No lab test can help doctors diagnose benign essential blepharospasm. It can be difficult to get a definitive diagnosis. A Japanese study reports that more than 60% of participants saw five or more doctors before receiving a diagnosis.

The diagnostic process usually begins with your primary care physician. They will perform a physical exam and review your medical history.

If they suspect an eye problem, they may refer you to an eye doctor. An eye doctor can examine your eyes to check for structural problems and help rule out other conditions.

Once a doctor has ruled out structural problems in your eye, they may refer you to a neurologist for further testing. A neurologist can perform tests such as an electromyogram to measure your muscle activity and a nerve velocity test to measure how fast electrical information travels through your nerves.

Doctors treat most cases of mild essential blepharospasm with botulinum toxin (Botox) injections to relax your muscles. These injections are made from a toxin produced by Clostridium botulinum bacteria.

Some people experience side effects from these injections, such as:

Side effects are usually temporary.

Other treatments doctors have used to treat benign essential blepharospasm with limited success include:

Reducing stress and minimizing eye strain by limiting screen time can help you manage your symptoms.

According to National Institute of Neurological Disorders and Strokemost people experience substantial relief with Botox injections.

The outlook for benign essential blepharospasm is highly variable. It ranges from a mild inconvenience to a serious condition that can affect quality of life. Some people can develop functional blindness because their eyes stay closed for hours.

In some cases, the condition worsens or spreads to surrounding muscles. In other cases, it remains the same for years or may even resolve spontaneously.

Here are some frequently asked questions about benign essential blepharospasm.

Is there a way to prevent benign essential blepharospasm?

There is no known way to prevent benign essential blepharospasm. Reducing eye strain and stress can help you manage your symptoms.

Can blepharospasm be a sign of a brain tumour?

Some brain tumors can cause eye twitches. For example, in a Case Study 2019, researchers examined an 8-year-old girl who had headaches and involuntary eyelid movements on both sides periodically for about 30 days. A brain scan revealed a brain tumor.

How long do Botox injections for blepharospasm last?

Botox injections start working within days and can last 2-3 months. After several Botox injections, the affected muscles may waste away. Symptoms of benign essential blepharospasm may go away to the point where you no longer need Botox.

Botox injections are effective in about 70% of people with blepharospasm.

Are people with blepharospasm allowed to drive?

If the twitching is severe and causes your eyelids to close completely, you may not be able to drive safely. In severe cases, the spasms can lead to your eyelids closing for hours and potentially legal blindness.

Blepharospasms are twitching of your eyelids. Most cases are minor and temporary, but some people have a condition called benign essential blepharospasm which can cause severe spasms in both eyes.

Doctors don’t know exactly what causes benign essential blepharospasm, but genetics may play a role.

It’s a good idea to see your doctor if your eyes close completely when you have twitching, if you develop twitching in other parts of your face, or if the twitching persists for more than two weeks.

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