Eye Conditions

Eyelid and hemifacial spasms occur from involuntary squeezing of the eyelid and facial muscles. These spasms may lead to lid closure and diminished view

The exact cause of eyelid and hemifacial spasms is not well understood, but the disease generates stimulation of branches of the cranial nerve that control facial and lid position.

Eyelid and hemifacial spasms are divided into “Blepharospasms” (lid spasms) and “Hemifacial Spasms”.


Blepharospasm presents with increased involuntary lid twitching and blinking. Blepharospasm usually begins after the fifth decade and is more frequent in women. The most severe forms of blepharospasm generate forceful involuntary lid closures that can affect visual acuity.

Environmental triggers are bright lights, television or computer monitor flicker. Stress and driving have been known to aggravate the spasms.

Hemifacial Spasms

Hemifacial spasms

Hemifacial spasm involves involuntarily contractions of only one side of the face. (Full facial spasms are known but occurs very rarely). Hemifacial spasm often presents with a phenomenon called “Synkinesis” in which the spams are incited during ordinary facial movements such as chewing or whistling.

It is twice as likely in women as men and, like blepharospasm, usually starts in the fifth decade of life. In severe cases there is lid closure but also unintended salivation (drooling) due to asymmetric lip positioning.

Treatment of Eyelid and Facial Spasms

Let your eye surgeon know if you are suffering from eyelid or facial spasms and they can recommend treatment options. Spasm reducing oral medications are available that might suppress involuntary spasms. In general these oral preparations are not very effective.

Microvascular surgery to relieve stimulating anatomical agents from the facial nerve has been proven very successful. Although 90% of patients improve with microvascular surgery, this method carries certain risks. Risks are permanent damage to the facial nerve resulting in facial paralysis. In more complicated cases deafness, brain bleeds, and death have been reported.

With the development of Botox injections for treatment of spasms, we have seen an eyelid and facial spasm suppression rate of about 80 – 85 %. Botox injections usually kick in 7-10 days after administration and can last for 4-6 months or more. The principal drawback of Botox is the need to constantly repeat the injections. Considering the comparative effectiveness with microvascular surgery, the low risk Botox option has become the preferred method for treating patients with eyelid and hemifacial spasms.