Blepharospasm (eye twitch)

Symptoms   Causes   Vitamins/Supplements   Treatment   Self help discussion   News

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.

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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.

7th Cranial Nerve

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. 8

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.6

Dry eyes and/or light sensitivity. Dry eyes and eye twitch are strongly linked,10 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.2
  • Many anecdotal accounts report treating blepharospasm with magnesium3, 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.

Complementary Treatment

Since mild blepharospasm may be related to stress, eye fatigue, or computer vision syndrome, addressing those issues can be helpful for many people.

  • Consider nutrients to support eye health overall and address dry eye and computer vision syndrome issues.
  • Acupuncture can be more effective than botox therapy. In a group of 30 patients half received botox and half received acupuncture. In both groups lower eyelid tension (LET), a measure used to diagnose blepharospasm severity, decreased, with slightly better results in the acupuncture group.13 Furthermore, some acupuncture techniques (Tonifying-Qi and Dredging-Meridian) are more effective than conventional acupuncture.
  • Self-help techniques can bring relief.

Conventional Treatment

Botulinum toxin is the approved medical treatment in the United States and Canada.9 It weakens the muscles by blocking the nerve impulses transmitted from the nerve endings of the muscles.

The benefits begin 1-14 days after treatment and lasts for an average of three to four months. The success rate is up to 90% in stopping the spasms (twitching).11

The side effects of this treatment may be drooping eyelids, blurred vision, and/or double vision. Side effects are usually short-term. Over an 18 to 29 year observation period (depending on the type of virus used, this treatment is considered safe. One patient in 69 tested positive for neutralizing antibodies against botulinum toxin A.12 Speak to your doctor for more details.

Drugs - no specific drug has been shown to be effective as of this time. Consult your neurologist for possible new medications.

Surgery - as a possible last resort. protractor myectomy is most effective for severe cases. This procedure removes the muscles responsible for closing the eyelids. Blepharoplasty is a related surgery.5

Self Help

You can try supplementing with magnesium, but you should check with your doctor if the condition is chronic. Because stress may be a contributing factor, sometimes paying attention to issues causing stress and self massage can be helpful.

  • Massaging the cheek, jaw and gum muscles can sometimes bring immediate relief for mild cases.
    • If you feel inside your mouth, you'll find the masseter muscle, a hard muscle near the back which moves up and down vertically.
    • Use your pointer finger at the top end of the masseter muscle, next to the upper gum and begin pressing firmly checking for tender places.
    • Press any tender spots for about 30 seconds, not too hard, just as much as you can stand. More pain is not helpful.
    • Work your way around the top of this muscle, pressing any tender spots.
    • In the same way, find tender spots and press for 30 seconds along the upper back gum line.
    • Generally it will take not more than 3-4 days for relief.
  • A warm compress over the upper face and eyes will help to relax the muscles and relieve muscle tension. If you have myokymia, with swelling, the warm compress can help to reduce swelling.
  • Other sensory tricks: try some of these, one at a time to see if they work for you.
    • Press fingers against temples, end of nose, or other facial location. It's different for each person.
    • Wear a tight headband or baseball cap.
    • Close your eyes and put your head back or look down.
    • Go to a dark place and sit quietly, not thinking of anything in particular. Don't try to relax; perhaps just notice your breathing.
    • Chew gum, whistle, hum, sing, suck on a straw.
    • Read aloud.
  • If possible, avoid drugs that contribute to or aggravate blepharospasm.
  • Stop or cut-down on caffeine intake, specifically coffee, tea, chocolate or any soft drinks with caffeine.
  • Stop smoking.
  • Dark glasses are helpful for your light sensitivity.
  • Make sure your computer setup uses proper ergonomics. Aim for an arm's length distance from the screen.
  • Smart phone users: don't hold your phone close to your eyes - this aggravates eye strain. Aim for a minimum of 12-14".
  • Use natural light if possible.
  • Take steps to reduce chronic stress at your job, and manage your stress with meditation or yoga. Take a walk.

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.7
  • Patients with blepharospasm may also develop other facial spasms known as Meige syndrome.

Eye Twitch News

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Resources & Footnotes

Benign Essential Research Foundation

1. Alonso-Navarro H, et al. (2006). Tardive blepharospasm associated with cinnarizine use. Clinical Pharmacology. July-August
2. Kanzato N, et al.(1999). Lambert-Eaton myasthenic syndrome with ophthalmoparesis and pseudo blepharospasm. Muscle Nerve. December.
3. Ploceniak, C. (1990). Bruxism and magnesium, my clinical experiences since 1980. Revue de Stomatologie et de Chirurgie Maxillo-faciale.
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. Das S, Sreedharan R, et al. (2016). Psychogenic Blepharospasm: A Diagnostic Dilemma. Shanghai Archives of Psychiatry. December.
7. de Verdal M, Renard D, et al. (2017). 123I-FP-CIT SPECT imaging in blepharospasm. Revue Neurologigue. June.
8. Defazio G, Hallett M, Jinnah HA, Conte A, and Berardelli A. (2017). Blepharospasm 40 years later. Mov Disord. Apr;32(4):498-509.
9. Yen MT. (2018). Developments in the Treatment of Benign Essential Blepharospasm. Curr Opin Ophthalmol. Sep;29(5):440-444.
10. Girard BC, Levy P. (2019). Dry Eye Syndrome in Benign Essential Blepharospasm. J Fr Ophthalmol. Dec;42(10:1062-1067.
11. Jochim A, Li Y, Gora-Stahlberg G, Mantel T, Berndt M, et al. (2017). Altered Functional Connectivity in blepharospasm/orofacial Dystonia. Brain Behav. Dec 18;8(1):e00894.
12. Jochim A, Meindl T, Huber C, Mantel T, Zwirner S, et al. (2020). Treatment of Blepharospam and Neige's Syndrome with Abo- and onabotulinumtoxinA: Long-Term Safety and Efficacy in Daily Clinical Practice. J Neurol. Jan;267(1):267-275.
13. Bao FF, Li QS, Zhang ZY, Xiang MH. (2019). Treatment Effects of Botulinum Toxin Injection and Acupuncture in Blepharospasm Assessed by the Change in Lower Eyelid Tension. Curr Eye Res. Jun;44(6):679-683.
14. Liu J, Xu H, Zhang R. (2014). [Efficacy Observation of Acupuncture Method of Tonifying-Qi and Dredging-Meridian for Blepharospasm]. [article in Chinese]. Zhongguo Zhen Jiu. Jan;34(1):37-40.