Spasms

Spasms - What it is

Eyelid spasm, or twitching (also called blepharospasm), is an abnormal, involuntary blinking or movement of the eyelids.

The blinking can happen every few seconds and may even be strong enough to make your eyelid shut entirely before reopening. The three most common types of eyelid spasms are:

Eyelid myokymia

Eyelid myokymia refers to involuntary fine contractions of the eyelid muscles, most commonly affecting the lower eyelid on one side. Although you may feel as though your eyelid or eye is ‘jumping’, it may not be noticeable to others unless the eyelids are closely observed.

The cause of eyelid myokymia is not well understood. It may be due to irritation of nerve fibres within the muscle or within the brain. It often begins at times of excessive stress or fatigue and may be associated with excessive alcohol or caffeine intake. It is usually intermittent, lasting for several hours at a time.

Eyelid myokymia usually resolves spontaneously after a few days to a few weeks, although occasionally it may last several months. Treatment is usually not necessary unless symptoms are severe.

Blepharospasm

Blepharospasm is an involuntary closure of both eyelids due to contraction of the eyelid muscles. It may be caused by irritative eye conditions, certain drugs and brain disorders. However, when none of these is present, the condition is called essential blepharospasm.

It most frequently affects women over the age of 50 and may begin as an increased frequency of blinking, particularly in response to sunlight or stress. It eventually progresses to involuntary spasms of eyelid closure.

Although the condition is thought to be due to dysfunction within the brain, the exact cause is uncertain. It may be mild and experienced simply as an increased blink rate with intermittent eyelid spasms or it can be a severely disabling condition in which the affected person is unable to read, watch television, becomes occupationally disabled, avoids social contact and may become depressed.

Hemifacial spasm

Hemifacial spasm is an involuntary contraction of the muscles on one side of the face. The disorder occurs in both men and women, although it more frequently affects middle-aged or elderly women.

The first symptom is usually an intermittent twitching of the eyelid muscle that can lead to closure of the eye. The spasm may then gradually spread to involve the muscles of the lower face, which may cause the mouth to be pulled to one side. Eventually the spasms involve all of the muscles on one side of the face almost continuously. Spasms may worsen with fatigue or anxiety.

Most cases of hemifacial spasm are caused by a blood vessel pressing on the facial nerve. Rarely, it can be caused by a tumour pressing on the facial nerve.

For this reason, patients who have this condition are advised to undergo brain imaging. Hemifacial spasm generally persists although, rarely, it may resolve spontaneously.

Spasms - Treatments

Eyelid myokymia usually does not require any treatment.

However, when persistent, treatment with medication or injections may be considered. Essential blepharospasm and hemifacial spasm may also be treated with medication, injections or surgery.

The treatment option will depend on the patient’s preference following discussion with the neuro-ophthalmologist and/or neurosurgeon.