Blepharospasm (eye twitch)

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That occasional annoying little tic in one eye might be the beginnings of blepharospasm, or it might simply be a warning that you are over-stressed, over-worked, over-focused, or over-tired. Probably almost all of us have experienced it at one time or another. In the environment of too many hours on the computer, many worries, and/or not getting enough sleep, it can be more than annoying. However, there's quite a bit you can do.

Blepharospasm (or eye twitch), also known as benign essential blepharospasm, is the involuntary twitching of the eyelids, caused by a dysfunction of the seventh cranial nerve. Usually it lasts just for a few minutes, hours, or days, but in severe cases may be chronic, and in rare cases, it may be difficult to open the eyes.

Certain nutrients such as magnesium malate chelate may help alleviate symptoms of blepharospasm.

Blepharospasm affects approximately 25,000 people in the U.S., usually in people aged 50-60. Women have three times greater incidence than men. It may occur in presence of stressful situations, bright lights and fatigue, especially during the day.It gets better during sleep.

Symptoms

• Eyelid twitching (myokymia may be a precursor to blepharospasm) - might be only barely visible if you look in the mirror
• Excessive blinking blink rate increases from its normal 10-12 blinks a minute.
• Light sensitivity, or the glare of daylight makes your eyes feel tired or you get a headache from the sun.
• Dry eyes, your eyes feel sore, watery, stinging.
• Eye strain or fatigue from not enough sleep or too many hours on the computer.

Types of Eye Twitch

There are three kinds of blepharospasm: bilateral, in which both eyes close suddenly, usually at the same time; pseudo-apraxic, in which both eyes close slowly at the same time; and combined, in which both types are experienced. In the case of eye fatigue or computer eye strain, involuntary twitching may be noticed in only one eye.

Causes

Blepharospasm has been thought to be caused by abnormal functioning of the basal ganglia nerve bundles, which are located below the cortex at the top of the spine. The basal ganglia control voluntary movements, routine movements such as eye movements, and emotion. Through the 7th cranial nerve, they link to its temporal and zygomatic branches that support the muscles of the eyelids and face.

Network problem. However, recent neurophysiological- and neuroimaging-based research suggest that several parts of the brain may be involved, and that blepharospasm may be more of a "network" problem which would explain the wide variety of experiences. ⁶

Stress. Because nerve activity can be impacted by stress, it is thought that stress and/or trauma to the head may contribute to or cause blepharospasm. In one case, a woman's serious blepharospasm condition was alleviated within seconds with a botox injection. More interestingly, on a return visit to retreat the condition she received a pin-prick in one eye, without medication, and had the same nearly instant benefit in both eyes.²

Dry eyes and/or light sensitivity. Dry eyes and eye twitch are strongly linked,⁸ although treatment for dry eye may not alone solve the problem for severe instances.

Some drugs may contribute to the incidence, as well as hormone replacement therapy. Another possible cause is withdrawal from benzodiazepine drugs for insomnia, anxiety, convulsions, alcohol withdrawal and muscle spasms. Some health conditions may increase the incidence of eye twitching, such as multiple sclerosis, AIDS, TB, Parkinson's, Tourette's syndrome, cerebral palsy, tardive dyskinesia, some infections, and some brain injuries or tumors.

Calcium / magnesium or potassium imbalance. It is thought by some health professionals that eye twitches may be aggravated by imbalances in calcium, magnesium and/or potassium levels. Magnesium is often recommended.

• In one instance a woman suffered from blepharospasm after long-term treatment of a calcium channel blocker, taken for dizziness.¹
• In another case, a patient with muscle weakness and pseudo blepharospasm was found to have elevated antibodies against calcium, and treatment with a potassium channel-blocker and an immune system suppressant reduced the eye muscle spasms.¹
• Many anecdotal accounts report treating blepharospasm with magnesium^{3, 4}
• Too high levels of potassium may contribute to blepharospasm.¹
• There has been little or no research about use of magnesium and calcium or too high levels of potassium - so check with your doctor or naturopath if you have chronic blepharospasm.
• There has also been a few reports of blepharospasm resulting from medications for travel sickness.¹⁰

Research

Although treatment for eye twitch hasn't essentially changed in the last 40-50 years, researchers now understand that the problem may involve a number of different brain regions, as evidenced by neurophysiological and neuroimaging. Regarding it as a "network disorder" accounts for the variety and severity of experiences.⁹

Related Conditions

• Dry eyes
• Computer eye strain
• Myokymia - sometimes a precursor to blepharospasm, myokymia is contractions of very fine muscles, usually on only one eyelid, usually on the lower eyelid. It differs from blepharospasm in that in the latter the eyelids blink open and closed. It may be accompanied by mild swelling.
• Facial myokymia is a rippling of the muscles and usually occurs on one side of the face and may be a symptoms of a tumor.
• Fasciculation - refers to any involuntary movement of the fine eye muscles.
• Dystonia - is the broader classification for involuntary muscle movement and blepharospasm is a type of dystonia affecting the eyes. Like blepharospasm, dystonia may be caused by stress, brain trauma, tumor, drug reactions, heavy metal poisoning or carbon monoxide poisoning or stroke.
• Parkinson's - chronic blepharospasm may be an indicator of Parkinson's disease. Note that this was a very small study evaluating use of a diagnostic imaging tool.⁵
• Patients with blepharospasm may also develop other facial spasms known as Meige syndrome.

Eye Twitch News

Want to learn more? See our blog news on blepharospasm.

Resources & Footnotes

Benign Essential Research Foundation

1. Kanzato N, et al.(1999). Lambert-Eaton myasthenic syndrome with ophthalmoparesis and pseudo blepharospasm. Muscle Nerve. December.
2. Das S, Sreedharan R, et al. (2016). Psychogenic Blepharospasm: A Diagnostic Dilemma. Shanghai Archives of Psychiatry. December.
4. Good Health, NZ. (2014). "10 signs that you're magnesium deficient"
5. Clayman M, King K, et al. (2017). Management of Essential Blepharospasm. Eplasty. June.
6. Defazio G, Hallett M, Jinnah HA, Conte A, and Berardelli A. (2017). Blepharospasm 40 years later. Mov Disord. Apr;32(4):498-509.
7. de Verdal M, Renard D, et al. (2017). 123I-FP-CIT SPECT imaging in blepharospasm. Revue Neurologigue. June.
-444.
8. Girard BC, Levy P. (2019). Dry Eye Syndrome in Benign Essential Blepharospasm. J Fr Ophthalmol. Dec;42(10:1062-1067.
9. Ibid. Defazio. (2017).
10. Alonso-Navarro H, et al. (2006). Tardive blepharospasm associated with cinnarizine use. Clinical Pharmacology. July-August