Last updated: July 28. 2014 6:46AM - 359 Views
By Dr. Tom Barowsky Contributing columnist

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It is not unusual for people to complain of fine twitching of the eyelid at times. This twitch or tic in the eyelid may occur in the lids of one or both eyes. They may last for a few minutes or hours. We are not sure why the twitches appear but they may be related to stress, fatigue, caffeine, nicotine or even dry eyes. By using artificial tears, reducing stress, cutting down on caffeine and nicotine and getting more sleep (wouldn’t all that be nice) the twitching will, in most cases, get better or disappear.

If you develop more severe twitching that causes the eyes to close or as the twitching becomes more severe you develop other facial muscle twitches, this could be the beginning of a condition called benign essential blepharospasm(BEB). BEB is forceful, uncontrollable closing of the eyelids. Often it affects both eyes, but it may affect just one eye. As this condition gets worse, the blinking and winking occurs more often and the patient may nod their head in an effort to improve vision through the spasms.

The exact cause of BEB is not known. Most experts believe there is a problem in a part of the brain called the basal ganglion. This problem may be hereditary. In addition, certain medicines such as those used to treat Parkinson’s Disease may cause the problem or make it worse. Other factors such as stress, fatigue and dry eyes may play a role. Bright lights may also make spasms worse and the wearing of dark glasses may reduce some of the spasm. In addition, the dark glasses will make the winking less noticeable to others and possibly avoid an embarrassing social situation with large jealous boyfriends.

Treatment of blepharospasm has changed dramatically over the years. Early on the treatment of choice was a special cushioned wire attached to the eyeglasses that would force the eyelid to stay open. Called a ptosis crutch this treatment was poorly effective and caused more problems than it corrected. Several surgical procedures were tried with varying amounts of success. The use of oral medication may help relieve the spasms but what worked for one patient might not work for another. Also, the benefits of the medicine often did not last long. Researchers continue to evaluate a number of medicines that may help relieve the spasm. Discontinuing medications that are known to cause spasm also has been of benefit.

Today the use of Botox in BEB has dramatically improved the lifestyle and reduced the disability caused by this condition in many patients. The injections are given into the effected muscle and must be repeated every three to six months to maintain control of the spasm. In the most severe cases a combination of oral medications, Botox and surgery may be required to bring an adequate level of relief for these patients.

Fortunately, blepharospasm is a rare condition affecting only a very small segment of the population. By using artificial tears, reducing your nicotine, caffeine, stress and fatigue factors your twitch should get better. This will help you feel better and enjoy life more.

(Editor’s note: If you have questions about your eye health e-mail Dr. Barowsky at doctom@tdkj.com and we’ll try to answer your questions here at Eye-Q.)

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