Eyelid spasms and facial spasms

Myokymia is an uncontrolled contraction (or quivering) of muscles along the lower and/or upper eyelids of one or both eyes. This usually results from anxiety and stress, fatigue, and caffeine. The contractions are often so small that they are not visible to others. Fortunately, this resolves on its own over several weeks.

Benign essential blepharospasm (BEB) is uncontrolled contraction of muscles around the eyes. The condition affects both sides and may result in a variety of problems including difficulty opening the eyes, rapid fluttering of the eyelids, or forced contraction of the lids and brows. When the mouth and neck are involved with the spasms, the condition is called Meige syndrome. The initial symptoms may be excessive blinking with progression to more forceful and frequent muscle contraction. The spasms disappear during sleep and may be made worse with bright lights, fatigue or emotional stress.

Aberrant facial nerve regeneration may occur after an episode of facial paralysis (e.g. Bell’s palsy) as an attempt by the body to reinnervate the paralyzed area. This rewiring can lead to eyelid twitching, drooping, and even tearing when other muscles of facial expression are activated (e.g. smiling, chewing).

Hemifacial spasm (HFS) is uncontrolled contraction of the muscles on one side of the face, usually including the eyelids. The initial symptom may be twitching of the eyelids, with progression to involve the muscles on one entire side of the face. The severity of symptoms may vary from mild fluttering to forceful contraction. Unlike blepharospasm, this condition occurs during sleep.

The cause of BEB is unknown. The diagnosis may be made by your physician examining you and observing your facial movements. Blepharospasm is a benign condition that requires no further diagnostic testing.

HFS is sometimes caused by irritation of the facial nerve at the base of the skull. This irritation may be the result of an abnormal blood vessel pulsating against the facial nerve. When the facial nerve is irritated, it causes the facial muscles to contract and spasm. Less than 1% of cases are caused by a tumor. Therefore, your physician may recommend magnetic resonance imaging (MRI).

Treatment

Myokymia will stop on its own, particularly if the underlying cause is addressed. Oral medications are rarely effective in treating blepharospasm or HFS. The benefits are variable and short-lasting. These medicines may have undesirable side-effects, with patients complaining of fatigue or “clouding” of their thoughts.

The most common treatment of BEB, aberrent facial nerve regeneration, and HFS is with botulinum toxin injections. Botulinum toxin is FDA approved for the treatment of these disorders. The toxin is injected into the muscles at several sites around the eyelids and brow to prevent unwanted contractions. The effects of botulinum toxin last an average of two to four months, and injections may be repeated as needed. This treatment has been found to be safe and effective. Side effects are uncommon and last only for a short time, and may include droopy eyelids and double vision.

Surgery may be recommended for BEB if botulinum toxin therapy is not successful. Protractor myectomy surgery removes the eyelid muscle responsible for eyelid closure. This surgery is successful for some but not all patients. Many patients still require botulinum toxin injections after myectomy surgery. Surgery for HFS may be contemplated if an aberrant blood vessel is found to be the cause. The surgery involves microvascular decompression of the vessel near the brainstem to relieve pressure on the facial nerve.

Dark glasses are a mainstay of supportive therapy, and serve two purposes. They block the bright lights (which worsen spasms), and they hide the eyes from other people. As stress makes these conditions worse, stress management intervention may be helpful.