Eyelid Spasms Usually Not Serious
Frequently, patients will come into my office complaining of focal twitching of their upper or lower lid. Usually the twitch starts spontaneously and continues intermittently for several hours, but may last for weeks at a time. Most patients are upset about the spasm for two main reasons. First, they are concerned that the spasm is the subtle sign of some ominous neurologic problem. Second, they are concerned that the spasm is cosmetically apparent and that others can easily see the twitching of the lid.
Although the cause of minor eyelid twitching (tic) is not known, the condition is very common and is not indicative of a serious neurologic problem. Certainly, twitching can be caused by just general eye irritation. However, most cases reveal a normal eye exam, yielding the diagnosis of minor eyelid spasm. The condition may also be brought on by stress or eye strain. Thus, warm soaks, stress reduction or correction of any refractive error can help speed the resolution of symptoms. These minor spasms are not visible to others, although they may feel that way.
When a patient has a simultaneous spasm of both eyes, which is uncontrollable, this is referred to as essential blepharospasm (EB). The symptoms of EB range from a mild intermittent spasms to severe spasms involving the entire face, which may be incapacitating. The condition is due to abnormal nerve impulses from the central basal ganglion region of the brain. Interestingly, EB usually disappears during sleep. The treatment includes the use of oral medications, biofeedback and injections of botulinum toxin. Botulism is a serious bacterial infection which causes muscular paralysis and possibly death in those infected. The toxin that the bacterium secretes has been isolated and used effectively to treat focal muscle spasms safely by local injection. Although the treatment has few side effects, it is not permanent and must be repeated every several months. Since surgical treatment of the condition is complicated with variable results, it is held as a last resort.
When only one side of the face displays a spasm, this is referred to as hemifacial spasm. Unlike EB hemifacial spasm persists while the patient sleeps. The most common cause for this condition is an arterial abnormality which creates pressure on the facial nerve, irritating it and causing it to fire sporadically. Although this condition is also treatable with botulinum toxin injections, many instances require a neurosurgical intervention to relieve the pressure on the facial nerve. While the surgery is generally successful, it is a major neurosurgical procedure which may result in serious complications.
