Blepharospasm (Eye Twitching)

What do you mean by Blepharospasm?

Blepharospasm is an ocular condition wherein there is abnormal contraction or twitching of the eyelids. It’s a neurological condition which is presented with forcible closure of the eyelids. The term “blepharospasm” is coined from Greek. ‘Blepharo’ stands for eyelid; hence, spasm of eyelid spasm is blepharospasm. In such cases, the patient complains “I can’t open my eyes / My eyes twitch and close on their own, my right eye is twitching or my left eye is twitching”.

It normally refers to Benign Essential Blepharospasm (BEB), which is a condition of the eyelids (eyelid diseases) characterized by focal dystonia that involves sustained and involuntary contracting movements of the muscles around the eyes. The term ‘essential’ depicts that the cause for this is idiopathic or not yet known. But certain factors such as stress, fatigue or an irritant can exacerbate the symptoms of blepharospasm. In a large number of cases, twitching is persistent for a long time, leading to lifelong challenges. In such cases, the symptoms are so severe that they may even lead to functional blindness.  The affected individuals’ eyelids feel like they are tightly closed and will not be able to open, unless he makes great efforts to do so. Patients have normal eyes, but for some amount of time, are effectively blind because they are not able to open their eyes.

Blepahrospasm SHOULD NOT be confused with:

  • Blepharitis – Allergies or infection leading to inflammation of the eyelids
  • Ptosis – Drooping of the eyelids due to paralysis or weakness of the levator muscle of the upper eyelid.
  • Hemifacial Spasm – A condition where there is non-dystonia that involves various muscles on one side of the face, many times involving the eyelid, and produced due to irritation of the facial nerve. Muscle contractions in this case are more rapid and short term as compared to those in blepharospasm, and the condition is almost always limited to one side.

Patients present with the following symptoms:

  • Dryness of the eyes
  • Photosensitivity – Sensitivity to the sun and bright light
  • Disorderly contracting movements and twitching of the ocular muscles and surrounding area of the face. Some of the individuals have twitching symptoms which extend into the nose, face and at times, the area of the neck.
  • Uncontrolled blinking and spasms of the eyes, which generally presents with unmanageable closure of eyelids lasting longer than the typical blink reflex, sometimes lasting minutes or even hours.

What causes blepharospasm?

Some causes of blepharospasm have been recognized; although, the causes of many cases of blepharospasm remain idiopathic or unknown. Some blepharospasm patients have a history of dry eyes and/or light sensitivity, but others appear with no previous eye problems before onset of initial symptoms.

Some drugs may instigate blepharospasm, as well as sensitivity to hormone treatments, including estrogen-replacement therapy for women in their menopausal age. Blepharospasm can also be a symptom of acute withdrawal from sleeping pills. In addition to blepharospasm being a withdrawal symptom, prolonged use of sleeping pills (benzodiazepines) can cause blepharospasm and is a known risk factor for the development of blepharospasm.

Blepharospasm may also come from abnormal functioning of the brain basal ganglia. Simultaneous dry eye and dystonias such as Meige’s syndrome (Oral facial dystonia – combination of two forms of dystonia, blepahrospasm & oromandibular dystonia) have been noticed. Blepharospasms may be produced by concussions in some rare cases, when a blow to the back of the head damages the basal ganglia.


  • Drug therapy – Drug therapy for blepharospasm has proved generally uncertain and short-term. Finding an effective regimen for any patient usually requires trial and error over time.
  • Botulinum Toxin Injections (Botox Treatment is a widely known example) have been used to induce localized, partial paralysis of the eyelid closing muscle (orbicularis oculi). This is the gold standard of care

Injections are generally administered every three months, with variations based on patient response, and usually give relief within a week of symptoms from the eyelid muscle spasms. Most patients can resume a relatively normal life with regular Botulinum Toxin Injection Treatments. A minority of sufferers (less than 1%) may develop minimal or no result from Botox injections and have to find other treatments. For some, Botulinum toxin diminishes in its effectiveness after many years of use.

Benign essential blepharospasm is treated with five 5 unit doses of Botox injected subcutaneously at the medial and lateral aspect of each lid and at the lateral canthus. Care should be taken to avoid injecting the mid portion of the upper lid in order to avoid paralyzing the levator palpebri superioris muscle and causing ptosis. In cases where the spasm spreads to other facial muscles and even to the neck, similar 2.5/ 5 unit injections are given subcutaneously at the site of the spasm.

To read more on benign essential blepharospasm, hemifacial spasm & meiges disease, read this blogpost by Dr. Debraj Shome:

Watch a patient with Hemifacial Spasm treated with Botox Injection by Dr. Debraj Shome:

Botox Treatment (Botulinum Toxin Injections) Blepharospasm & Hemifacial Spasm, Mumbai, India

Benign Essential Blepharospasm / Hemifacial Spasms, Meige’s syndrome and other causes of eye twitch (eyelid spasms or involuntary eye muscle spasms) are eyelid/ eye spasms (involuntary muscle spasms /…