Eyelid Twitching | Blepharospasm
Eyelid twitching is a common condition. People usually notice that one eye feels as if the muscles around the eye involuntary twitch, causing blinking sometimes. In most cases, this is caused by lack of sleep, too much caffeine intake, or stress. The medical term for this is orbicularis myokymia. This can be really annoying! Fortunately, it is not associated with long-term problems with your vision or your health. For mild occasional twitching - especially if it is only on one side - we usually recommend trying to decrease caffeine intake, get more sleep, and see if it resolves. In some cases, we can treat this with a low dose of BoTox injections.
Some patients have a more serious condition called blepharospasm. Blepharospasm is a condition in which the eyelids spasm, closing involuntarily, forcing the patient to blink excessively abnormally. Blepharospasm is a form of focal dystonia or abnormal contractions of the eye muscles. Patients with blepharospasm have normal vision, but the disturbance interferes with visual perception and may, in severe cases, result in functional blindness. Dr. Eftekhari is board-certified has extensive experience treating blepharospasm both with medical treatment and surgery. He also has published academic research in this area because there is a dire need for better treatments for these patients.
If you are interested in reading a summary of blepharospasm written by Dr. Eftekhari when he was on university faculty at the University of North Carolina at Chapel Hill, please click the link below:
For information about our study on using Ritalin to treat blepharospasm, click this link:
Causes of Blepharospasm
We don't really know what causes blepharospasm, but the way Dr. Eftekhari explains it to patients is that there is a mismatch between your eye and your brain. Normally, your eyelid twitches when its windy, or dust gets into your eye. This is because a signal is sent from the surface of your eye to the deepest part of the brain - called the basal ganglia - and the brain sends a signal back to your eyelids to tell them to blink. This is on purpose! You want your eyelids to blink when there's dust in your eye or it's windy. And you don't want to have to think to do it. It is involuntary and happens by itself.
In patients with blepharospasm, there is a mismatch between the eye and the brain. The eye might perceive some dust or wind, but the signal the brain sends back is way too strong. This faulty circuit leads to excessive eyelid twitching and blinking. In rare cases, patients cannot open their eyes and their eyelids get stuck. This is known as apraxia of eyelid opening and is a serious manifestation of this condition.
In some cases, there seems to be a genetic component to blepharospasm since there is evidence of family history of this disorder or other types of dystonia. There has been a lot of research into whether blepharospasm is linked to Parkinson's disease. Sometimes, patient's with Parkinson's will have eyelid twitching as part of their Parkinson's. However, there is no clear link between benign essential blepharospasm and Parkinson's disease. Another way of saying it is: if you have blepharospasm, that does NOT mean you will automatically get Parkinson's disease.
Symptoms of Blepharospasm
Blepharospasm is progressive, usually beginning with excessive eyelid twitching, blinking and eye irritation. This can happen in the presence of stress factors such as bright lights, fatigue or emotional distress. Almost always present in both eyes, as the condition progresses symptoms occur more and more frequently, interfering with daily activities. Symptoms of blepharospasm do not occur during sleep and patients may experience a period of relief from symptoms upon waking. When the disorder becomes extreme, patients may be unable to open their eyes for hours at a time.
As times blepharospasm may occur with dystonia affecting the mouth and jaw, or oromandibular dystonia. In oromandibular dystonia, the patient involuntarily grimaces, clenches the jaw muscles and sticks out the tongue. When blepharospasm and oromandibular dystonia occur concurrently, the disorder is called Meige's syndrome. Patients with blepharospasm may experience continuing sensitivity to bright light and dry eyes.
Diagnosis of Blepharospasm
At present, there is no specific test for blepharospasm and, in most cases, laboratory results in patients with the disorder are normal. Blepharospasm is typically diagnosed on the basis of:
- Patient history
- Physical examination
- Neurological evaluation
Medical diagnosis is necessary to distinguish blepharospasm from other conditions affecting the eyelids, such as infection, allergy, and other conditions resulting in muscular weakness or contractions.