Blepharospasm: Types, Causes, Symptoms, Diagnosis and Treatment

It occurs when someone experiences involuntary muscle spasms and contractions of the eye muscles. The term is often referred to as BEB (for its acronym in English).

Blepharo is a word used to describe the “eyelid,” Spasm means “uncontrolled muscular contraction,” but what does Blepharospasm mean? Anyone with Blepharospasm or BEB flashes abnormally or has a tic or tic of the eyelid.

This includes people who suffer from dry eyeTourette syndrome, or tardive dyskinesia, which is a disorder that causes repetitive body movements, such as grimacing and clicking on the lips.

People who have Blepharospasm will often hear the word dystonia. This describes abnormal involuntary muscle contractions. It is important to note that those with Blepharospasm have normal eyes.

The visual disturbance they experience is simply due to the forced closing of their eyelids.

What are the types of Blepharospasm?

When considering a definition of Blepharospasm, it is essential to keep in mind that there are different types. Some people have primary Blepharospasm, while others have secondary Blepharospasm.

Primary Blepharospasm: in this case, a definition of Blepharospasm is dystonia, which is characterized by involuntary contractions of the muscles of the face that closes the eyelids. These are called the orbicularis oculi muscles.


It includes the blinking of the eyelids and could be related to eyelid apraxia, which is the difficulty opening the eyelid. Primary Blepharospasm usually does not appear along with any other neurological disease symptoms.

Secondary Blepharospasm: This type of Blepharospasm is usually due to external factors, such as physical trauma, exposure to certain drugs, other neurological or metabolic diseases, and, sometimes, brain injuries.

It has been linked to Meige syndrome, which is characterized by energetic movements of the jaw and tongue; Breughel syndrome, a condition that causes facial, tongue, and neck muscle spasms along with clamping of the jaw.

Extrapyramidal disorders are abnormal movements, such as tics and stiffness in the neck and extremities, and reflex Blepharospasm. This involuntary reflex can occur due to dry eye or light irritation.

Of the two types described above, primary Blepharospasm is the most common.


The causes of Blepharospasm are still being investigated; however, the current theory has something to do with the functioning of the basal ganglia, which is a group of structures at the base of the brain that is responsible for coordinating movement.

Some believe that there is some defect in a neural circuit that leads to Blepharospasm.

The secondary causes of Blepharospasm may be due to an organic disease:

  • Eye injuries, especially in the cornea.
  • Conjunctivitis, iritis, or keratitis (Different types of eye inflammation).
  • Dry eyes.
  • Ocular surface disease.
  • Glaucoma o uveítis.
  • Multiple sclerosis.
  • Brain injury or a tumor.
  • Atypical Parkinson’s disease.
  • Infections (viral encephalitis, tuberculosis, and AIDS).
  • Tourette’s Syndrome.
  • Late dyskinesia.
  • Cerebral palsy.
  • Adverse reactions to medications.
  • Blepharitis (inflammation of the eyelids).

When we talk about the causes of Blepharospasm, it is essential to note that there may be a genetic component, although small. There is only a five percent chance that Blepharospasm will be inherited.

It is also believed that the symptoms of Blepharospasm, such as eye shaking, can be attributed to stress in some people.

In short, nervous activity is affected by stress. Some health experts also suggest that eye shaking can be aggravated by calcium and magnesium imbalances.

In one case, a woman began to suffer Blepharospasm after a long period of treatment with a calcium channel blocker that was prescribed for dizziness.

In another case, a person with muscle weakness had elevated antibodies against calcium, but treatment with a potassium channel blocker and an immunosuppressant reduced ocular muscle spasms.

Some people with Blepharospasm have been treated successfully with botulinum toxin (Botox). In one study, 90 percent of patients showed improvement with Botox in just a couple of days.

However, there may be complications associated with such treatment, including those listed below:

  • Bruises.
  • Blepharoptosis (abnormal low upper eyelid).
  • Ectropion (the eyelid turns outwards).
  • Excess watering of the eye.
  • Double vision.
  • Lagophthalmos (inability to close the eyelids completely).
  • Corneal exposure.

What are the symptoms and risk factors?

When the symptoms of Blepharospasm begin, they are often frequent and include forced blinking and eye irritation. Certain stimuli, such as emotional tension, bright lights, wind, or air pollution, can worsen Blepharospasm symptoms.

BEB almost always impacts both eyes. Some patients find that the frequency of muscle spasms increases and causes a narrowing of the opening between the eyelids. In other words, it can be difficult for some people to keep their eyes open.

In severe cases, a person’s eyes may be closed for several hours.

For the most part, spasms and contractions occur during the day and disappear when an affected person is sleeping. Symptoms of Blepharospasm reappear when the person wakes up in the morning.

Some studies suggest that an increase in blinking may precede Blepharospasm. Depression is also a symptom of this condition.

Although the study of Blepharospasm continues, several risk factors have been observed, including head and face trauma, family history of dystonia, severely dry eyes, sensitivity to light, extreme stress, and medications used to treat Parkinson’s disease.

There was a time when health professionals thought that smoking cigarettes was a negative risk factor for Blepharospasm, but recent research does not support this theory.

How to diagnose it

History is one of the factors that are considered when making a diagnosis. The doctor’s account allows for determining if the patient’s condition may be primary Blepharospasm or secondary Blepharospasm.

Episodes of involuntary spasms can interfere with the patient’s daily routine, so they should be analyzed and a physical examination.

A physical examination can observe involuntary movements and involve an ocular inspection. Neurological tests, such as magnetic resonance or CT, do not reveal anything about Blepharospasm, but they can rule out other conditions.

Laboratory tests are also of little use in the diagnosis of Blepharospasm.

A panel of neurologists and ophthalmologists has evaluated the clinical features associated with Blepharospasm. From the evaluation, guidelines were established to help doctors diagnose Blepharospasm.

Involuntary narrowing of the eyelid, closure due to a spasm, spasms around both eyes, the pattern of spasms, intermittent resting count, and the inability to suppress pangs voluntarily are factors that a physician should observe in a patient.

There is no known cure for Blepharospasm, but in most cases, it does not affect a person’s ability to live a whole life. Most people with this condition can develop forms of coping, combining treatments such as Botox and emotional support.

Treatment and Prognosis of Blepharospasm

Usually, Blepharospasm symptoms appear and disappear during the day. When a patient is asleep, the symptoms do not bother him, but the eye blinks and begins to blink again as soon as he wakes up.

The exact cause of BEB is unknown, but there is a treatment for Blepharospasm.

Each case of Blepharospasm is different depending on the underlying cause. A doctor will help determine the best possible Blepharospasm treatment based on that underlying cause.

For example, if an eye trauma is part of the problem, treatment with Blepharospasm is likely different from the treatment prescribed for someone who has Tourette’s syndrome or some other type of health disorder.

The following list shows how to stop Blepharospasm:

Stress management: learning stress management techniques can be helpful for those suffering from Blepharospasm because it is known that stress and anxiety worsen symptoms.

Botulinum (Botox): made of botulinum toxin type A, when injected, Botox can interrupt nervous messages to the muscles and cause paralysis. Typically, multiple injections are administered above and below the eye.

One or four days later, paralysis begins. The total effect occurs in about a week. The treatment with Botox lasts up to four months. There may be side effects, such as dry eyes, drooping eyelids, and double vision.

A specially trained neurologist, ophthalmologist, or neuro-ophthalmologist should administer the injections.

Medications: If Botox does not work, the motility medications can be used to control Blepharospasm. Sometimes, drugs such as diazepam (Valium) are used, but they have varying success rates.

Surgery: A myomectomy is a procedure that involves partial or total removal of the eyelid and eyebrow muscles that are responsible for squinting. This operation is usually only done if Botox does not work.

Myectomy improves Blepharospasm symptoms in up to 80 percent of cases; however, some people find that they require repeated operations.

When treating Blepharospasm with botulinum injections, the research suggests that 90 percent of patients improve, although you should keep in mind that continuous injections are required.

It is also important to remember that treatment for Blepharospasm often adjusts over time and that patients may have other medical conditions that prevent them from undergoing specific therapies.

Natural treatment options

Some natural Blepharospasm treatment options can be considered. It is essential that, if you suffer from BEB, you tell your health care team how you treat your condition.

The following list describes some potential natural treatments:

Massage: Massaging the cheek, jaw, and gum muscles can sometimes provide instant relief to those suffering from mild Blepharospasm. There is a complex muscle near the back of the mouth called a masseter.

This muscle moves up and down vertically. Using the index finger on the top of the masseter and pressing it firmly can be effective. Pressing must continue at any sensitive point of that muscle for 30-second intervals.

People who have had success with this type of massage indicate that they felt relief in three or four days.

Headband: Some people have reported that wearing a tight headband or baseball cap has helped reduce symptoms, at least temporarily.

Movements of the mouth: exercising the mouth by chewing gum, whistling, humming, singing, or sucking a straw is helpful for some who suffer. Others say that reading aloud works well for them.

Positioning: closing the eyes and putting the head back or looking down

Diet: avoid caffeine, especially coffee, tea, chocolate, and soft drinks.

Dark glasses: Some people with Blepharospasm are sensitive to light, so wearing dark glasses can be comforting. It can also be helpful to rely on natural light whenever possible when indoors.

Meditation: Using meditation to cope with the general stress or stress associated with the condition can be helpful. Some people find that they only go to a dark place, and focusing on their breathing makes a difference. Yoga and a walk are other options.

Chiropractic: a chiropractor can relieve eye shaking. Chiropractors are professionally trained in the realignment of bones and muscles in the body.

Acupuncture: trained acupuncture specialists can insert needles into various body points. Many people find that acupuncture effectively relieves their chronic pain, and some have discovered that it can treat their Blepharospasm.

Acupuncture for Blepharospasm would probably involve inserting the needles into the muscles around the eyes.

Hypnosis: This means that a person is placed in an altered state of consciousness. A hypnotherapist offers suggestions that will become part of the patient’s memory once the session is over. The idea is that the tips lead to answers that will help alleviate the symptoms.

Pets like dogs and cats can also suffer from Blepharospasm.

Any condition that irritates the eyelids can cause blepharitis, which includes:

Congenital abnormalitiesCongenital abnormalities can also cause a dog to be prone to blepharitis, including entropion, a condition in which the edges of the eyelid turn inward, along with eyelash abnormalities in which they grow toward the eye rather than outward.

Allergies: allergies to insect bites and inhaled allergens can also cause blepharitis.

Form of the face and snout of a dog: the facial folds, the long and narrow bills, and the flat and short faces predispose the dogs to develop Blepharospasm.

Infections: bacterial infections such as staphylococci, abscesses of glands in the eyelids, and occasionally, a fungal infection can lead to Blepharospasm.

Tumors: The tumors found in the Meibomian glands can be benign adenomas or malignant adenocarcinomas. A mast cell tumor can also cause blepharitis.

  • Inflammatory disorders.
  • External trauma in the eyelids.
  • Localized scabies (caused by mites).
  • Nutritional disorders
  • Endocrine problems include hypothyroidism, Cushing’s disease, or diabetes.
  • Environmental irritants such as tobacco smoke.
  • An underlying cause can not be found in some cases, and Blepharospasm is considered idiopathic.

Take good care of your health and also that of your pets.