Blepharospasm or Uncontrolled Flicker of the Eyelid

Blepharospasm or uncontrolled flicker of the eyelid.The term blepharospasm ['blef-a-ro-spaz-m] can be applied to any abnormal blinking or eyelid tic or twitch resulting from any cause, ranging from dry eyes to Tourette's syndrome to tardive dyskinesia. It is caused by a dysfunction of the area of the brain that controls the muscles around the eye. Other facial muscles can twitch as well, particularly those around the cheek and brow. Severe cases can cause the eyelids to forcibly close for a longer period than the typical blink, disrupting vision.

In the early stages it may only occur with specific precipitating stressors, such as bright lights, fatigue, and emotional tension. As the condition progresses, it occurs frequently during the day. The spasms disappear in sleep, and some people find that after a good night's sleep, the spasms don't appear for several hours after waking.



Blepharospasm is thought to be due to abnormal functioning of the basal ganglia which are situated at the base of the brain. The basal ganglia play a role in all coordinated movements. It appears that there is a disturbance of various "messenger" chemicals involved in transmitting information from one nerve cell to another. In most people blepharospasm develops spontaneously with no known precipitating factor. 

It has been observed that the signs and symptoms of dry eye frequently precede and/or occur concomitantly with blepharospasm. It has been suggested that dry eye may trigger the onset of blepharospasm in susceptible persons. Infrequently, it may be inherited. Blepharospasm can occur with dystonia, a neurological movement disorder, in which sustained muscle contractions might affect the mouth and/or jaw (oromandibular dystonia, Meige syndrome). In such cases, spasms of the eyelids are accompanied by jaw clenching or mouth opening, grimacing, and tongue protrusion.    

Blepharospasm can be induced by drugs, such as those used to treat Parkinson's disease. Reducing the drug dose may alleviate the problem.

Symptoms occur most frequently in persons who are between the ages of 50 and 70. Women are three times more likely to develop the condition than men are. 

The progression of symptoms includes:
  • Spasms in response to particular triggers, such as fatigue or bright lights
  • Spasms occurring more frequently during the day, whether the triggers are present or not
  • Spasms forcing the eyelids shut for hours at a time � spasms also pull the eyebrows down towards the eyes.


Treatment Options


Blepharospasm or uncontrolled flicker of the eyelid.The preferred treatment for many patients is the injection of botulinum toxin (Botox). Although the same bacterium responsible for botulism food poisoning produces this toxin, it is safe in minute doses and effective in stopping eyelid spasms. Botulinum toxin is injected with a very fine needle into the eyelid, the brow, or the muscles under the lower lid. It starts working in 1 to 14 days and lasts an average of 3 to 4 months. Then the patient needs another injection. Click here to know about the dosages & number of injections required to be administered. 

Whether or not botulinum A toxin is working can be easily determined by asking patients to squeeze the eyelids shut intensely and then try to forcibly pry the eyelids open with the fingers. The patient with normal squeezing requires significant force with the fingers to force the eyelids open, whereas paralysis of the muscles of the eyelids allows the eyelids to be opened easily. This simple test differentiates true "failures of botulinum A toxin", in which the squeezing muscles are not weakened by the toxin, versus those cases that have associated deformities or problems.


Drug treatment for blepharospasm requires patience, as finding a successful mix of drugs and doses may take some time. Some drugs (such as lithium and diazepam (Valium)) are more effective for some patients than others, and certain drugs may produce short-term benefits, unpleasant side effects or both. It is important to follow the instructions of your ophthalmologist or neurologist, and report side effects if they occur.


Functionally impaired patients with blepharospasm who have not tolerated or responded well to medication or botulinum toxin are candidates for surgical therapy. The principle is to stop contraction of an eye muscle called - Orbicularis. At present, protractor myectomy (removal of some or all of the muscles responsible for eyelid closure) has proven to be the most effective surgical treatment for blepharospasm. Current experience has found that myectomy has improved visual disability in 75-80% of cases of blepharospasm. The first and easiest group of patients to treat with myectomy surgery are those in whom botulinum A toxin weakens the squeezing muscles, but have developed excess baggage in the eyelids, stretching of the levator aponeurosis or tendon that raises the upper eyelids (ptosis), droopy brows, and on some occasions, mal-positions or in-turning or out-turning of the eyelids and the lashes.

Blepharospasm or uncontrolled flicker of the eyelid.Blepharospasm symptoms tend to worsen in times of emotional stress. Learning stress management techniques and joining a support group can be helpful. Dark glasses are the commonest aid. They fulfill two functions. They reduce the intensity of sunlight which bothers many people with blepharospasm, and they hide the eyes from curious onlookers. Lid hygiene to decrease irritation and blepharitis should be encouraged. Frequent applications of artificial tears and punctal occlusion to alleviate dry eyes often improve symptoms.

Join a support network. Sufferers have a fear of sustained attacks and feel safer staying amongst familiar surroundings, putting them at risk of social isolation.


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Dated 13 February 2012

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