What is benign essential blepharospasm?
Benign essential blepharospasm is uncontrolled contraction of muscles around the eyes. The condition affects both sides and may result in a variety of problems including difficulty opening the eyes, rapid fluttering of the eyelids, or forced contraction of the lids and brows. The initial symptoms may be excessive blinking with progression to more forceful and frequent muscle contraction. The spasms disappear during sleep and may be made worse with bright lights, fatigue or emotional stress.

What is hemifacial spasm?
Hemifacial spasm is uncontrolled contraction of the muscles on one side of the face, usually including the eyelids. The initial symptoms may be twitching of the eyelids, with progression to involve the muscles on one entire side of the face. The severity of symptoms may vary from mild fluttering to forceful contraction. Unlike blepharospasm, this condition occurs during sleep.

What causes blepharospasm?
The cause of blepharospasm is unknown. Blepharospasm is a benign condition that requires no further diagnostic testing.

What causes hemifacial spasm?
Hemifacial spasm is sometimes caused by irritation of the facial nerve at the base of the skull. This irritation may be the result of an abnormal blood vessel pulsating against the facial nerve. When the facial nerve is irritated, it causes the facial muscles to contract and spasm. Less than 1% of cases are caused by a tumor. Therefore, your physician may recommend magnetic resonance imaging.

What are treatment options?
The most common treatment of these conditions is with botulinum toxin injections. The toxin is injected into the muscles at several sites around the eyelids and brow to prevent unwanted contractions. The effects of botulinum toxin last an average of three to four months, and injections may be repeated as needed. This treatment has been found to be safe and effective. Side effects are uncommon and transient, and may include droopy eyelids and double vision. Surgery may be recommended for blepharospasm if botulinum toxin therapy is not successful. Protractor myectomy surgery removes the eyelid muscle responsible for eyelid closure. This surgery is successful for some but not all patients. Many patients still require botulinum toxin injections after myectomy surgery.

What other supportive measures are helpful?
Dark glasses are a mainstay of supportive therapy, and serve two purposes. They block the bright lights which worsen spasms, and they hide the eyes from other people.