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Eyelid Spasms (Blepharospasm)

The most common types of eyelid spasms are: eyelid twitch (or myokymia), benign essential blepharospasm, and hemifacial spasm. An eyelid twitch is a common symptom characterized as a sudden, involuntary twitching of the eyelid muscles, generally around one eye. Eye twitching and eyelid spasms are repetitive, uncontrollable blinking and/or spasms of the eyelid, usually affecting the upper lids. Benign essential blepharospasm often affects the eye muscles of both eyes.

Most people develop a minor eyelid twitch or benign essential blepharospasm at some point in their lives, although the cause is generally unknown. The most common things that make the muscle in your eyelid twitch are fatigue, stress, and caffeine. Once spasms begin, they may continue off and on for a few days and typically do not occur during sleep. Most people have this type of eyelid twitch once in awhile and find it very annoying. It is painless and harmless and usually goes away on its own, but can be quite frustrating. It is especially true if the spasms are strong enough to cause the eyelids to completely shut and then reopen.

In some cases eye twitching is more than a temporary nuisance. Some people have spasms that occur frequently throughout the day. Symptoms can recur for days, weeks, or even months. This can cause a lot of emotional distress and interfere with quality of life. In its most serious forms, blepharospasm or eyelid spasms can become chronic. It can cause persistent winking and squinting and if it progresses to the point where you have difficulty keeping your eyes open, it can cause severe vision impairment. In this case, a number of our patients have found relief with botulinum toxin (Botox) injections repeated on average every 3 months.

Benign essential blepharospasm and hemifacial spasm are uncommon, chronic, and disabling medical conditions. Both disorders result in constant and uncontrollable blinking which interferes with the performance and enjoyment of many day-to-day activities and may even render a patient functionally blind and occupationally handicapped. If you are unsure whether you have one of these conditions, a diagnosis can be made by Dr. Paul examining you and observing facial movements.

Hemifacial spasm is quite rare and involves more than just the eyelid muscles. It also usually involves the muscles around the mouth. Unlike other types of eyelid twitching, it usually affects only one side of the face. In most cases, hemifacial spasm is caused by an artery pressing on the nerve to the facial muscles. The initial symptoms may be twitching of the eyelids with progression involving the muscles on one entire side of the face. The severity of symptoms vary from mild fluttering to forceful contraction. Unlike blepharospasm, this condition can occur during sleep. Less than 1% of cases can be caused by a tumor in which case Dr. Paul may recommend magnetic resonance imaging (MRI).


  • Blepharitis (inflammation of the eyelids)
  • Dry eyes
  • Sensitivity to light
  • Pink eye

Undiagnosed corneal scratches can also cause chronic eyelid twitches. If you think you have an eye injury, make an appointment with Dr. Paul immediately as corneal scratches can sometimes cause permanent eye damage.

Eyelid spasms can also be a symptom of a more serious brain or nerve disorder. When the eyelid twitches are a result of these more serious conditions, they are almost always accompanied by other symptoms. If Dr. Paul suspects that a brain or nerve disorder is responsible for eye twitching, he will examine you for other common signs. Brain and nerve disorders that may cause eyelid twitches include:

  • Bell’s palsy (facial palsy): causes one side of your face to droop downward
  • Dystonia: causes unexpected muscle spasms and the affected area’s body part to twist or contort
  • Multiple sclerosis (MS): a disease of the central nervous system that causes cognitive and movement problems, as well as fatigue
  • Parkinson’s disease: causes trembling limbs, muscle stiffness, balance problems, and difficulty speaking
  • Tourette’s syndrome: characterized by involuntary movement and verbal tics


Researchers believe that eye twitching may result from a combination of environmental and genetic factors. Although the condition is usually random, it sometimes runs in families. Eyelid twitches are rarely serious enough to require emergency medical treatment. However, chronic eyelid spasms may be a symptom of a more serious brain or nervous system disorder as noted above. You should make an appointment to see Dr. Paul if you’re having chronic eyelid spasms and any of the following also happens:

  • Your eye is red, swollen, or has an unusual discharge
  • Your upper eyelid is drooping
  • Your eyelid completely closes each time your eyelids twitch
  • The twitching continues for several weeks
  • The twitching begins affecting other parts of your face


Most eyelid spasms go away without treatment in a few days or weeks. If they don’t go away, you can try to eliminate or decrease potential causes. The most common causes of eyelid twitch are stress, fatigue, and caffeine. To ease eye twitching, you might want to try the following:

  • Drink less caffeine
  • Get adequate sleep
  • Keep your eye surfaces and membranes lubricated with over-the-counter artificial tears or eye drops
  • Apply a warm compress to your eyes when a spasm begins

Dr. Paul may sometimes recommend Botox to treat chronic headaches which cause eye twitching or blepharospasm. Botulinum toxin (Botox) is regarded as the most effective treatment of choice for the rapid but temporary treatment of blepharospasm. More than 95% of patients with symptoms report significant improvement with use of the toxin. The toxin causes temporary paralysis of the associated muscles with a peak of effect at 5-7 days after injection. Patients typically note the onset of relief 3 days after injection, with a duration of relief from symptoms of 3 months. More than 5% of treated patients have sustained relief for more than 6 months, although some patients require injections as often as monthly.