What Causes a Blepharospasm?

Reviewed on 1/23/2023
Causes of Blepharospasm
Blepharospasm is characterized by an increased frequency and intensity of blinking.

Blepharospasm is caused by an abnormal function of the basal ganglia for unknown reasons. The basal ganglia are the region of the brain that controls the muscles.

Blepharospasm could be brought on by several factors, including diet, too much caffeine, physical activity, and fatigue. Blepharospasm is a rare hereditary disorder. People who have inherited blepharospasm exhibit generalized dystonia. (Dystonia is a neurological condition characterized by muscle spasms.)

Other factors that cause blepharospasm include:

What is blepharospasm?

Blepharospasm, commonly called eye twitching, is a type of focal dystonia that causes abnormal, involuntary spasms of the muscles surrounding the eyes and brows. These spasms happen continuously, and the eyes blink repeatedly.

Blinking 10 to 20 times per minute is normal. Blepharospasm is characterized by an increased frequency and intensity of blinking. Though it is a chronic illness, it is not fatal. Women aged between 40 and 60 years are more prone to developing blepharospasm.

Blepharospasm is classified into two types:

  1. Primary blepharospasm
    • The most common type.
    • Occurs without the signs of any other neurological or metabolic condition.
    • Researchers believe unidentified brain alterations cause it.
  2. Secondary blepharospasm
    • Caused by an external source, such as physical trauma, medications, or neurological disorders, such as brain lesions or metabolic disorders.

Blepharospasm usually starts slowly, with excessive blinking or ocular discomfort, occasionally just in one eye. It may occur exclusively with triggering stresses, such as strong lights, exhaustion, and emotional strain, in the early phases. As the illness worsens, it becomes more common throughout the day.

The spasms go away while you sleep. Some individuals report that after a full night's sleep, the spasms do not come back for many hours after waking up. Focusing on a single job may help reduce the frequency of spasms.

As the condition worsens, the spasms may become so severe that the person is functionally blind when they occur, and the eyelids may remain tightly closed for many hours.

Laughing, singing, and yawning may temporarily relieve discomfort. Reading, watching TV, and driving may aggravate symptoms.\

What are the symptoms of blepharospasm?

The symptoms in the early stages of blepharospasm include:

  • Persistent, involuntary blinking of eyes
  • Ocular discomfort
  • Tiredness
  • Emotional distress
  • Sensitivity to bright lights
  • Sensitivity to wind or air pollution

In advanced stages, facial muscles are involved and spasms occur in the tongue, lips, and neck and result in the following:

  • Jaw clenching
  • Grimacing
  • Tongue protrusion

How is blepharospasm diagnosed?

The diagnosis of blepharospasm is based on the clinical exam. The person’s medical history will be thoroughly analyzed and a neurological assessment could be done.

Radiological imaging tests for the brain and eyes are performed.

Scans, such as X-rays, MRIs, and CTs, are done to allow the physician to examine possible abnormalities.


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How is blepharospasm treated?

There is no cure for blepharospasm, but there are numerous therapeutic options available to help manage the condition and minimize the intensity of symptoms.

  • Botox injections
    • Botulinum toxin, often called Botox, is administered into the muscles of the eyelids.
    • The most commonly prescribed, effective, and least intrusive treatment for blepharospasm. These injections relax the eyelid muscles and cause spasms to stop.
    • The relief is just temporary, lasting several months.
    • The shots can be administered as many times as necessary.
    • Side effects of Botox are rare but may include:
    • If you have severe blepharospasm, especially functionally blind, the increased vision and pain relief would surpass the side effects.
  • Medications
    • A wide range of medications have been studied to determine if they can help people with blepharospasm, but none appear to be reliably successful.
    • Oral medications, such as clonazepam, benzhexol, and baclofen, relieved symptoms in about 33 percent of people.
    • However, the degree of relief is usually inadequate compared to the adverse effects they cause.
  • Surgery
    • People with blepharospasm may benefit from myectomy surgery in terms of functional improvement.
    • Generally indicated after nonsurgical treatments are ineffective.
    • Myectomy eliminates virtually all muscles of the upper eyelid, which help blink.
    • These muscles are removed by incisions in the brow and the eyelid crease.
    • As an adjuvant to this therapy, botulinum toxin could be used post-operatively.
  • Coping strategies
    • By managing their symptoms, many people were able to avoid surgery.
    • Many control their symptoms daily by:
      • Using drops for dry eyes
      • Warm and cold compresses on the eyes to reduce inflammation
      • Sunglasses are used to protect eyes from light
      • Activating the facial muscles by talking or singing

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Image Source: iStock image

Blepharospasm Dystonia of the Eyelids & Brow. https://dystonia-foundation.org/what-is-dystonia/types-dystonia/blepharospasm/

Blepharospasm. https://www.aanem.org/Patients/Muscle-and-Nerve-Disorders/Blepharospasm

Blepharospasm - Involuntary Movements of Eyelids. https://www.news-medical.net/health/Blepharospasm-Involuntary-Movements-of-Eyelids.aspx

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