Most people have experienced an episode of a twitching eyelid: either upper or lower or both. The twitch usually occurs suddenly and may last for just minutes or continue for days and rarely longer. It is annoying and may cause some anxiety, but is rarely associated with severe eye or neurological conditions. The most common causes of twitches are: stress, lack of sleep, stimulants (e.g. caffeine) and dry eyes. Eliminating these factors usually reduces and eventually eliminates the twitching.
When should someone be concerned that the twitchy lid is more than just an annoyance?
If the twitching persists and is associated with more forceful closure of the lids, then benign essential blepharospasm (BEB) needs to be considered. This condition is bilateral (affecting both sides), may begin with mild and infrequent spasms on one side, but ultimately there is more frequent and forceful lid closures on both sides. In severe cases the closure is so severe that it causes a “functional blindness” preventing normal daily activities including reading and driving. The spasms disappear during sleep and can sometimes be reduced by concentrating on a specific task. BEB is a disease of exclusion: more severe neurological conditions and/or other causes of eyelid closures as outlined above need to be excluded.
Who is affected by BEB and how common is it?
The condition usually begins in people between 40 and 60 years of age as is at least twice as common in women. It is an unusual disease and only about 2,000 cases are diagnosed in the U.S. yearly.
What factors are associated with or may increase the severity of BEB?
-Trauma to the face or head
-Family history of movement disorders or tremors
-Some medications that are used to treat Parkinson’ Disease
-Inflammation of the eye and surrounding tissues
-Severe dry eyes
What causes BEB and can it be prevented?
The exact underlying cause is not known, but the condition is thought to be caused by “malfunction” of certain brain centers (basal ganglia) or possible over activity of the facial nerves which control the muscles of eyelid closure. In the primary form of BEB, no prevention is possible. As discussed previously, certain factors can exacerbate the spasms (inflammation, dry eye, stress) and elimination of these conditions is helpful in reducing or eliminating the spasms.
Are there any special tests to determine if someone has BEB?
As discussed, BEB is a “diagnosis of exclusion”. The diagnosis is made on the basis of history and clinical exam and by excluding other potential local or neurological causes. It is usually not necessary to undergo special testing (CT scan or MRI) to make the diagnosis
Treatment of BEB
In the past several oral medications have been used in an attempt to reduce or eliminate the spasms: muscle relaxants, sedatives, Ritalin. None of these have been proven to be effective and are rarely prescribed.
Botulinim Toxin (e.g. Botox,Dysort)
Periodic injection of Botulinum Toxin has become the mainstay of medical treatment of BEB and is effective in 90% of patients. Injections are given into the muscles that are associated with eyelid closure. The amount and number of injections varies from patient to patient and usually requires approximately one week for maximum effect. The effect is almost always temporary and treatment can be repeated every 3 to 4 months.
Since the introduction of Botulinum Toxin, surgical (partial) removal of the eyelid muscles associated with eyelid closure is infrequently used. Unfortunately, even with surgery, the condition may persist and Botulinum Toxin is still necessary to control the spasms
Post by Dr. Philip Silverstone. Dr. Silverstone is a specialist in Ophthalmic Plastic and
For more information about the treatment of eyelid twitches, BEB, or to discuss any
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