Blepharospasm (Eye Twitching)

What is blepharospasm?

Blepharospasm is a neurologic disorder that causes uncontrollable muscle movements that causes the eyelids to close or have difficulty opening (dystonia). This can affect patients’ ability to see.

How common is blepharospasm?

It’s a rare disease and can be difficult to diagnose. Approximately 2,000 people are diagnosed with it each year.

How does blepharospasm affect my body?

Symptoms start with uncontrollable eyelid twitching (spasms) that comes and goes. It usually starts gradually and gets worse over time. As the disease progresses, you may experience constant blinking, and the opening between your eyelids may narrow. In advanced cases of blepharospasm, you may not be able to keep your eyes open or may be difficult to open your eyes.

Will blepharospasm cause me to become blind?

Blepharospasm does not affect your vision, but it can lead to functional blindness. When you cannot keep your eyes open, it limits your ability to perform daily tasks.

Symptoms and Causes

What causes blepharospasm?

Researchers are still working to confirm its cause. Blepharospasm may be due to abnormal electrical activity in the basal ganglia, structures deep within the brain that help control movement.

Who gets blepharospasm?

Usually people get blepharospasm in middle age, but it can happen to anyone. Sometimes dry eye may look like blepharospasm so it is important to see your healthcare provider to rule out other causes for your excessive blinking. You could also experience blepharospasm if you take certain medications. For example, medications for Parkinson’s disease can cause blepharospasm.

People with certain medical conditions can get blepharospasm. These conditions include:

• General dystonia.
• Meige syndrome.
• Tardive dyskinesia.
• Wilson’s disease.

What are the symptoms of blepharospasm?

In the early stages, you may have frequent blinking and the symptoms come and go. You’ll experience them during the day, and they’ll go away while you are sleeping. As the disease progresses, they become more severe with fewer periods of relief.

You may experience:

• Constant blinking.
• Dry eyes.
• Eye narrowing.
• Tired, irritated eyes.
• Difficulty keeping your eyes open.

Diagnosis and Tests

How is blepharospasm diagnosed?

Healthcare providers diagnose blepharospasm after asking about your medical history and performing a physical exam. Because it is a rare condition, it’s important to seek care from a specialist familiar with it.

Will I need any tests?

No laboratory tests are necessary.

Management and Treatment

What treatments are available?

There are three types of treatment for blepharospasm:

• Medications you take by mouth, including drugs that block involuntary muscle movements (anticholinergics), but their effect is usually limited.
• Botulinum toxin injections, which weaken the eye muscles’ ability to twitch. Botulinum toxin is one of the most effective treatments for blepharospasm. There are several variations available.
• Surgery (myectomy), a procedure to remove part or all of the overactive eye muscles.

Which blepharospasm treatment is right for me?

It depends on the severity of your symptoms and response to therapy. The most common and most effective treatment is botulinum toxin. Medications are effective in a small number of people. But they often cause side effects such as memory problems, drowsiness and dry mouth. When blepharospasm is not improved with medical therapy, surgery may be indicated.

How long do botulinum toxin effects last?

Botulinum toxin injections are placed in muscles around the eyes to relieve constant blinking and eye narrowing in many people. Various patterns and doses of botulinum toxin can be used. Botulinum toxin usually lasts three to four months.

Does Botox cause side effects?

A small number of people experience temporary side effects that include:

• Blurred vision.
• Double vision.
• Dry eye.
• Ptosis (drooping eyelid).

Who needs surgery?

Usually surgery for blepharospasm is reserved for patients that do not do well with botulinum toxin and/or medications, but you and your healthcare provider will decide what’s best for you.

Prevention

Can I prevent blepharospasm?

Unfortunately, there is not much to do to prevent blepharospasm, but there are options to help. Seeking care from an experienced healthcare provider can help you start treatments sooner.

What can I do to keep symptoms from getting worse?

Some patients find it helpful to use special lens filters in their sunglasses or eyeglasses, such as rose tinted FL-41 lenses. In addition, optimizing dry eye treatment is helpful to decrease and eye irritation from dry eye.

Outlook / Prognosis

What is life with blepharospasm like?

As blepharospasm advances, you may not be able to control blinking or keep your eyelids open. This can affect your ability to perform daily tasks. You may need to adjust your lifestyle by:

• Taking public transportation if it’s not safe for you to drive.
• Wearing glasses with special filters, such as rose tinted or FL-41 lenses, to reduce sensitivity to light.
• Knowing when to ask for help, like when you are crossing the street or need assistance taking care of yourself.
• Adjusting your home or work environment, so it’s easier to access important objects.
• Adjusting work or other activities if you can no longer see well enough to perform them.

Are there other therapies that can help me manage blepharospasm symptoms?

Learning stress management techniques, like deep breathing and mindfulness, may quiet symptom triggers. In addition, some patients find trigger points on their face to help decrease the frequency and intensity of spasms.

Living With

Are there nonmedical therapies I can use for symptom relief?

Steps you can take include:

• Wearing sunglasses or tinted lenses to shield your eyes. Glasses with large lenses that extend back toward your temples are best.
• Using hats with brims to provide extra protection against bright lights.
• Keeping your distance from or sitting with your back against windows that let in a lot of light.

Where can I receive support to help me cope with life changes due to blepharospasm?

There is a national organization called the Benign Essential Blepharospasm Foundation (BEBRF–www.blepharospasm.org) where you can find helpful information and community support. In addition, your healthcare provider can direct you to community resources for people with limited vision. Referrals may include support groups and special activities for people with vision issues. Your loved ones can also be a valuable source of support and encouragement.