Blepharospasm (Eye Twitch) - Causes, Symptoms, Diagnoses and Treatments

What Is Blepharospasm?

Blepharospasm, otherwise called benign essential blepharospasm, is a rare condition affecting the eyelids, which makes the eyelid blink or twitch involuntarily. It is a progressive neurological disorder. Muscle contractions cannot be controlled as they result from muscle spasms around the eye. Other minor causes can make the eyes twitch, like myokymia.

Points to Remember:

• This condition rarely runs in families.

• It is believed to originate in the motor nerves of the brain, but the exact cause is still not known.

• It can be triggered by stress, fatigue, dry eyes, eye strain, and some medications.

Classification:

• Mild: Occasional spasms that do not significantly interfere with daily activities.

• Moderate: More frequent spasms that may interfere with activities but are manageable.

• Severe: Frequent and intense spasms that significantly impair vision and daily functioning.

In addition, blepharospasm can be categorized as primary or secondary:

• Primary: Also known as benign essential blepharospasm, this form occurs without any identifiable underlying cause and is thought to be related to abnormal function in the basal ganglia of the brain.

• Secondary: Resulting from an underlying condition or trigger, such as eye irritation, neurological disorders, or adverse reactions to medications.

What Causes Blepharospasm?

The cause of most cases of blepharospasm is not known, but many hypotheses explain the possible causes. Some of the possible causes are:

• Dry Eyes and Light Sensitivity - Some patients have these symptoms before developing blepharospasm. However, most patients did not have any eye problems previously.

• Certain Drugs - Medicines used to treat Parkinson’s disease and hormone replacement therapy can induce blepharospasm. It can also be a withdrawal symptom of benzodiazepines.

• Abnormal functioning of the basal ganglia of the brain.

• It is also associated with conditions like dystonia and multiple sclerosis.

• It can also result from a concussion from a head injury.

• Eye injury or trauma.

• Environmental factors can trigger this condition.

What Are the Symptoms of Blepharospasm?

The signs and symptoms include:

• Excessive blinking due to spasms of the eye muscles.

• Sometimes, the twitches are so strong that they result in eyelid closure for minutes to hours.

• Involuntary twitches or contractions of the muscles surrounding the eye.

• Eye dryness.

• Eye irritation.

• Light sensitivity.

The symptoms become obvious when the person is tired or upset. Initially, the symptoms may be felt in one eye only, but as it progresses, both eyes get involved. The symptoms appear only when the patient is awake, and a good night’s sleep helps delay the onset of symptoms the next day. In advanced cases, the patient experiences severe spasms, making it difficult to open their eyes. Repeated attacks make the person functionally blind, as the patient cannot open the eyes and see even after having normal eyesight.

Most people suffering from blepharospasm also develop symptoms of dystonia in other parts of the body, like the neck, face, and mouth, eventually.

How Is Blepharospasm Diagnosed?

Blepharospasm is diagnosed clinically by a neurologist or ophthalmologist. There is no specific test to diagnose this condition, and diagnosis is made by ruling out all other causes of eye twitches. After a complete medical and physical examination, the doctor will rule out the following conditions before diagnosing the condition:

• Myokymia.

• Eye problems.

• Meige syndrome.

• Parkinson’s disease.

• Tourette’s syndrome.

• Hemifacial spasm.

• Focal seizures.

• Brain injury or tumor.

How Is Blepharospasm Treated?

There is no cure for this condition, but treatment can reduce the symptoms. The treatment options include:

• Medicines - Anticholinergics, tranquilizers, and botulinum toxin are used. But, it results in a lot of side effects and is not prescribed commonly. Nowadays, Mosapride is being used in the treatment, which is a safer and more economical option.

• Botox injection - Injecting Botulinum toxin is the preferred treatment option, as it induces localized paralysis. This injection is administered every three months. Most patients respond well to Botox injections and lead an almost normal life. For some, the effectiveness reduces after years of use.

• Surgery - If the symptoms are not relieved with the help of medicines or Botox, then surgery is done. During surgery, the muscles responsible for closing the eyelid (protractor myectomy) are removed.

• Sensorimotor Retraining - A Series of sensorimotor training techniques include exercises to improve neuroplasticity, which will help the brain heal itself and eliminate dystonic movements.

• Sensory Trick - A new device is used to apply pressure to the temple region, which helps patients open their eyes.

What Are the Home Remedies for Blepharospasm?

Symptoms can be managed by:

• Wearing protective sunglasses.

• Using lubricating eye drops.

• Apply hot or cold compression to the eyes and surrounding areas.

• Keep using the facial muscles to whistle, sing, and talk.

• Manage stress with stress-reducing techniques like deep breathing or yoga.

• Limit caffeine and alcohol, which can exacerbate muscle spasms and eye twitching.

What Are the Other Common Causes of Eyelid Twitches?

Eyelid twitches can be due to:

• Eye strain.

• Eye irritation.

• Sleep problems.

• Tiredness.

• Too much stress.

• Exertion.

• Side effects of some medicine.

• Alcohol or tobacco use.

Eyebrow twitches can be due to:

• Excessive caffeine.

• Magnesium deficiency.

• Eye strain.

• Allergies.

• Stress.

What Are the Other Serious Conditions That Can Cause Eyelid Twitches?

Everybody experiences eye twitching at some point. But rarely, it can be due to severe underlying conditions like:

• Bell’s Palsy, or Facial Palsy - Results in one-sided paralysis of the face.

• Dystonia - Results in unexpected and involuntary muscle spasms anywhere in the body.

• Multiple Sclerosis (MS) - A disorder that causes cognitive and movement problems and muscle weakness.

• Parkinson’s Disease - Results in involuntary tremors in the limbs, muscle stiffness, and balance problems.

• Tourette Syndrome - Results in involuntary movement and verbal tics.

Conclusion:

Blepharospasm is a twitching of the eyes caused by rapid, uncontrollable twitching or flexing of the muscles in or around the eyes. In extreme situations, the spasms may push the pupils closed, impairing vision. Blepharospasm is commonly seen in middle-aged women. The exact cause is not known, but genetic, environmental, and other factors seem to play a role. There is no cure for this disease as of now, but to know more ways to relieve symptoms, consult a doctor online.