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  • A benign nervous system condition characterized by uncontrollable eyelid spasms
  • Symptoms include loss of ability to control eyelid movements, uncontrolled blinking, frequent blinking
  • Treatment includes Botox injections, tinted glasses, medication, surgery, psychotherapy
  • Involves oculoplastic & orbital surgery, ophthalmology, neurology, neuro-ophthalmology
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Blepharospasm is the term for eyelid spasms that cause uncontrollable blinking or winking.

A person with blepharospasm cannot control the muscles responsible for opening and closing their eyelids. Blinking may become more forceful, and they may blink more frequently than desired. Sometimes, blepharospasm forces the eyelids shut for hours at a time, causing periods of functional blindness: People cannot see, although they may have healthy eyes and excellent vision.

Blepharospasm affects women more often than men, and it typically affects older adults—it’s more prevalent among 50- to 70-year-olds. The condition is somewhat uncommon, affecting about 50,000 Americans.

Untreated blepharospasm may also lead to depression or anxiety if the condition means a person is unable to open their eyes for periods of time. The condition may significantly detract from a person’s quality of life, preventing them from working, watching TV, reading, driving, seeing their loved ones, or getting around independently. Over time, blepharospasm may affect other facial muscles, potentially causing spasms in the eyebrows or jaw.

A variety of treatments are available to manage blepharospasm, tailored to address specific causes of the condition.

What is blepharospasm?

Blepharospasm is a benign (noncancerous) condition of the nervous system that causes uncontrollable eyelid spasms. A person with this condition may lose the ability to control their eyelid muscles, leading to excessive or forceful blinking and/or periods of time when the eyes are clenched shut.

Although blinking is an involuntary bodily function, most people are able to control the muscles that open and close their eyes. Blepharospasm brings a loss of that control. Episodes may occur only occasionally at first, but the frequency of eyelid muscle spasms typically increases over time. If the problem is not diagnosed and properly treated, the condition may interfere with a person’s ability to live life normally, including to drive or work.

Blepharospasm is different from the eyelid muscle twitches (called myokymia) that sometimes occur when people are sleep-deprived or stressed. Those involuntary fluttering twitches only arise periodically when someone is tired or under stress. While these symptoms can be annoying, they do not impair vision (as a result of causing the eyes to squeeze shut). Myokymia is generally not a life-long, chronic condition and resolves with rest or reduced stress.

What causes blepharospasm?

Doctors aren’t sure what causes blepharospasm, although the condition may stem from abnormalities in an area of the brain that impacts muscle movement. In addition, exposure to bright light and certain medications may be triggers for the condition.

What are the symptoms of blepharospasm?

People with blepharospasm may experience the following symptoms, which may improve or worsen gradually over time:

  • Become unable to control their eyelid muscles
  • Blink or wink uncontrollably and forcefully
  • Blink more frequently than usual
  • Become unable to reopen their eyes when they are forcefully shut, often for long periods

Additionally, people with blepharospasm may notice discomfort related to the eyes, including:

  • Dry eye
  • Sensitivity to light
  • A feeling that something gritty is in the eye
  • A burning sensation in the eye
  • Tearing
  • Eye pain

Typically, symptoms occur bilaterally (i.e., in both eyes) when people are awake and disappear when they’re asleep.

It’s important to note that when people with blepharospasm experience functional blindness, their vision isn’t impaired; they are only unable to see because their eyelids will not open.

What are the risk factors for blepharospasm?

People are at increased risk of blepharospasm if they have:

  • Dry eye
  • Sensitivity to bright light
  • High levels of stress
  • Anxiety
  • Sleep disorders
  • Prior head trauma
  • Parkinson’s disease
  • Brain lesions
  • A family history of blepharospasm
  • A family history of muscle spasms or tremors
  • Facial palsy
  • Myasthenia
  • Meige syndrome
  • Tourette’s syndrome

Additionally, certain medications, including those that treat Parkinson’s disease, raise the risk of blepharospasm.

How is blepharospasm diagnosed?

Blepharospasm can be diagnosed after you share details about your symptoms and medical history with a doctor, then undergo a physical examination. There are no diagnostic tests routinely used to confirm blepharospasm.

During the medical exam, it’s important to tell your doctor about your eye spasms: How long they have affected you, what triggers bring them on, whether they cause functional blindness, and any other details. If you have dry eye, Parkinson’s disease, facial palsy, Tourette’s syndrome, or other conditions that could affect your eyelid muscles, share those details with your doctor as well. Also mention any family history of blepharospasm or muscle spasms elsewhere in the body.

During a physical exam, your doctor will examine your eyes, noting your blinking frequency and whether it is voluntary. They may induce your blink reflex by tapping your forehead or startling you to see if it appears normal. Doctors may also look for the presence of spasms in other facial muscles.

Blepharospasm is a clinical diagnosis. Although uncommon, some doctors may offer the following diagnostic tests while assessing patients for blepharospasm, possibly to rule out other conditions:

Magnetic resonance imaging (MRI) scan, which can identify abnormalities in regions of the brain that control muscle movement

Electromyography (EMG) study, which can confirm that your muscles contract involuntarily

How is blepharospasm treated?

There is no definitive cure for blepharospasm. However, symptoms can be managed by a number of treatments, including:

Botulinum toxin A (Botox) injections. This is the preferred treatment for many patients. Doctors inject a small amount of this toxin into specific muscles that control eyelid function. It minimizes or prevents the eyelid muscles from spasming for several months. Treatment dosages and patterns are individualized for each patient so getting to a stable state may take more than one treatment session. Patients must receive injections every few months to manage symptoms.

Wearing tinted lenses. Exposure to bright light may trigger blepharospasm symptoms in some people. Wearing tinted glasses or sunglasses indoors may prevent eyelid spasms.

Switching your medication regimen. If doctors confirm that the medicine you take is causing your eyelid muscles to spasm, your medication may be changed to eliminate symptoms.

Medication. Various medications can treat mild cases of blepharospasm.

Surgery. If other treatment options aren’t effective, doctors may remove or destroy the problematic eyelid muscles with surgery. Most people need periodic botulinum toxin A injections after surgery to control symptoms.

Seeing a psychotherapist. People with blepharospasm who experience depression, anxiety, or suicidal thoughts because of complications like functional blindness may benefit from talk therapy and other treatments.

What is the outlook for people with blepharospasm?

The best way to minimize or eliminate blepharospasm symptoms is to keep up with treatments prescribed by your doctor. For example, many people schedule botulinum toxin A injections regularly. Other treatment options may prevent symptoms from arising, or keep them at bay for short or long periods of time, enabling people with blepharospasm to improve their quality of life.

What makes Yale unique in its treatment of blepharospasm?

“Here at Yale, we are subspecialized and thus uniquely qualified to specifically evaluate eyelid functioning,” says Michelle Maeng, MD, a Yale Medicine ophthalmologist and specialist in oculofacial plastic, reconstructive, and orbital surgery. “The robust interdisciplinary team of ophthalmologists, neurologists, and psychiatrists allows each patient to receive comprehensive care that is right for them.”