Eyelid Spasms

Eyelid spasms are involuntary muscle movements around the eye. They can be mild or more severe, and may affect just the eyelids or other parts of the face. Several conditions can cause eyelid twitching or spasms.

Myokymia

This is a light twitch or quiver of the upper or lower eyelid. It’s usually caused by:

• Stress

• Fatigue

• Caffeine

It typically affects one eye and goes away on its own within a few weeks. It’s harmless, though annoying.

Benign Essential Blepharospasm (BEB)

This is a more serious form of eyelid spasm. It affects both eyes and can cause:

• Frequent blinking

• Eyelid fluttering

• Forced eyelid closure

• Difficulty keeping the eyes open

The cause of BEB isn’t known. It often starts as excessive blinking and can progress over time. Bright light, fatigue, and stress can make it worse.

Meige Syndrome

When spasms affect the mouth or neck as well as the eyes, it’s called Meige syndrome. It often begins with excessive blinking and can include jaw or facial tension. Symptoms usually disappear during sleep.

Hemifacial Spasm (HFS)

This condition causes spasms on one side of the face, including the eyelid. It may begin with mild twitching and progress to more forceful muscle contractions. Unlike BEB, HFS continues during sleep. It’s often caused by irritation of the facial nerve, sometimes from a blood vessel pressing on the nerve near the brainstem. An MRI may be needed to evaluate the cause.

Aberrant Facial Nerve Regeneration

After facial paralysis (like Bell’s palsy), the nerves may regrow in a way that misconnects muscles. This can cause twitching, tearing, or eyelid drooping when other muscles are activated—like smiling or chewing.

Botulinum Toxin Injections

The most common and effective treatment for BEB, HFS, and facial nerve miswiring is botulinum toxin injections:

• Injected into the eyelid and brow muscles

• Helps stop unwanted muscle contractions

• Effects last 2–4 months

• Side effects are uncommon and may include temporary droopy eyelids or double vision

Medications

Oral medications are usually not effective and may cause fatigue or mental fog.

Surgery

Surgery may be considered when injections don’t provide enough relief:

• For BEB: Myectomy surgery removes eyelid muscles

• For HFS: Microvascular decompression relieves pressure on the nerve if a blood vessel is causing the spasms

Supportive Therapies

• Dark glasses can help by blocking light and reducing self‑consciousness

• Stress management (like relaxation techniques) may help reduce symptoms

Eyelid spasms range from mild twitches to conditions that affect your ability to see and function comfortably. Treatments like botulinum toxin injections and supportive care can offer relief. Your oculofacial plastic surgeon can help determine what’s causing your symptoms and recommend the right approach.