ConditionEyes & vision
Blepharospasm (Benign Essential Blepharospasm)
Blepharospasm is a neurological movement disorder in which the muscles around both eyes contract involuntarily, causing excessive blinking and forced eyelid closure. It is a focal dystonia, caused by abnormal signaling in the brain's movement circuits, not by an eye disease. It usually starts in middle age, more often in women, and can become severe enough to cause functional blindness even though the eyes themselves are healthy. Botulinum toxin (Botox) injections every 3 months control symptoms in most people.
Also called: Benign essential blepharospasm, BEB, essential blepharospasm, focal eyelid dystonia
At a glance
- What it is
- A focal dystonia causing involuntary blinking and squeezing shut of both eyes.
- Who gets it
- Usually adults aged 50 to 70; women about twice as often as men.
- Triggers
- Bright light, stress, fatigue, reading, driving and screens.
- Key distinction
- Unlike common eyelid twitching, it affects both eyes, closes the lids and persists.
- Treatment
- Botulinum toxin injections, treating dry eye, tinted lenses, and rarely surgery.
When to get help
See a doctor within a day or two
- Eyelid closure with a painful red eye, reduced vision or light sensitivity with headache
- New facial spasms with weakness, drooping or numbness of the face
Book a routine appointment
- Frequent blinking or forced eye closure in both eyes that lasts weeks
- Eyelids closing while driving, reading or walking
- Spasms spreading to the jaw, mouth or neck
- Spasms affecting one side of the face, including the cheek and mouth (possible hemifacial spasm)
Usually safe to manage at home
- Fine twitching of one eyelid for days after stress, poor sleep or caffeine (eyelid myokymia)
What blepharospasm is
Blepharospasm is a type of dystonia, a group of movement disorders in which muscles contract involuntarily. In blepharospasm, the orbicularis oculi muscles that close the eyes are affected. The problem lies in the basal ganglia and related brain circuits that control movement, not in the eyes or eyelid muscles themselves.
It is called "benign essential" because it is not life-threatening (benign) and has no identifiable cause (essential). It can, however, be very disabling.
Symptoms
Symptoms usually develop gradually:
- Early: increased blinking, eye irritation, dryness, grittiness and light sensitivity. Many people are first treated for dry eye.
- Progression: more frequent and forceful blinking, then spasms that squeeze the eyes shut for seconds to minutes.
- Severe: the eyelids may close for long periods, making it impossible to see, drive or read, despite normal eyes.
Spasms are often worse with:
- bright light, sunlight, glare and screens
- stress, fatigue and social situations
- reading, watching TV or driving
Many people discover "sensory tricks" (geste antagoniste) that briefly relieve spasms, such as touching the eyebrow or temple, humming, talking, singing, chewing gum or yawning. Symptoms often ease during sleep and on waking.
When blepharospasm spreads to the jaw, mouth, tongue or neck, it is called Meige syndrome.
Blepharospasm vs other eyelid problems
| Condition | Features |
|---|---|
| Eyelid myokymia (eyelid twitching) | Fine flickering of one eyelid; harmless; triggered by stress, caffeine and tiredness; settles in days to weeks |
| Blepharospasm | Both eyes; forceful closure; persistent; worse with light and stress |
| Hemifacial spasm | One side of the face; eyelid plus cheek and mouth; often from a blood vessel pressing on the facial nerve |
| Tics | Brief, repetitive movements that can be suppressed briefly, often starting in childhood |
| Reflex blinking from eye disease | Dry eye, blepharitis or a foreign body; improves when the eye problem is treated |
| Apraxia of eyelid opening | Difficulty opening the eyes without spasm; often with Parkinson's-type conditions |
Causes and risk factors
Most blepharospasm is primary, with no cause found. Contributing factors:
- Age and sex: onset in the 50s to 70s, more common in women
- Genetics: a family history of dystonia or tremor in some people
- Dry eye and eye irritation: may trigger or worsen it in susceptible people
- Medicines: long-term use of antipsychotics and some medicines for Parkinson's disease (levodopa) can cause it
- Brain conditions: Parkinson's disease, progressive supranuclear palsy, stroke or MS affecting the brainstem or basal ganglia (secondary blepharospasm)
Diagnosis
Diagnosis is clinical, based on the pattern of spasms and examination, usually by a neuro-ophthalmologist or neurologist. A doctor will:
- examine the eyes for dry eye, blepharitis or other irritation
- observe spasms and check for sensory tricks
- examine the rest of the face, neck and limbs for other dystonia or Parkinson's signs
- review medicines
Brain MRI is usually only needed if there are other neurological signs, the spasms are one-sided, or the course is atypical.
Treatment
Botulinum toxin injections
Injections of botulinum toxin (such as onabotulinumtoxinA) into the muscles around the eyes are the most effective treatment, improving symptoms in most people. Effects start within a few days and last about 3 months, so injections are repeated. Side effects can include temporary drooping of the eyelid, double vision, dry eye or tearing.
Supportive measures
- Treat dry eye with artificial tears, ointment and treatment of blepharitis.
- Tinted glasses: FL-41 rose-tinted lenses reduce light sensitivity for many people.
- Use sensory tricks and manage stress and fatigue.
- Eyelid crutches attached to glasses can help hold the lids open.
Medicines
Oral medicines such as clonazepam, trihexyphenidyl or baclofen help some people but often cause side effects such as sleepiness and confusion, and are generally less effective than injections.
Surgery
For people who do not respond to injections:
- Myectomy: removal of some of the muscles that close the eyelids
- Deep brain stimulation: considered in severe, widespread dystonia including Meige syndrome
Outlook
Blepharospasm is usually lifelong, though spontaneous remission occurs occasionally. It often worsens over the first few years, then stabilizes. With regular botulinum toxin treatment, most people can drive, read and work normally.
Frequently asked questions
What causes blepharospasm?
Blepharospasm is caused by abnormal function in the brain's movement control centers, making the eyelid muscles contract involuntarily. The exact cause is usually unknown. Genetics, dry eye, some medicines and conditions such as Parkinson's disease can contribute.
Is blepharospasm the same as eyelid twitching?
No. Ordinary eyelid twitching (myokymia) is a fine flicker of one eyelid that is harmless and goes away on its own. Blepharospasm affects both eyes, causes forceful blinking and closure, and persists. It needs medical treatment.
How is blepharospasm treated?
The most effective treatment is botulinum toxin injections into the eyelid muscles every 3 months or so. Treating dry eye, wearing tinted lenses and using sensory tricks also help. Medicines and surgery are options when injections are not enough.
Can blepharospasm cause blindness?
Blepharospasm does not damage the eyes, but severe spasms can keep the eyelids closed for long periods, causing functional blindness. Treatment usually restores the ability to see and carry out daily activities.
Does blepharospasm get worse over time?
It often progresses over the first few years, with more frequent and stronger spasms, and may spread to the lower face or jaw. It then tends to stabilize. Regular treatment controls symptoms well for most people.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: Blepharospasm
- National Eye Institute: Blepharospasm
- National Institute of Neurological Disorders and Stroke: Dystonia
- Benign Essential Blepharospasm Research Foundation: About BEB
- American Academy of Neurology: Practice guideline update on botulinum neurotoxin for blepharospasm