Dr Ben Wild
Overview |
The eyelids are full of muscles. From the orbicularis muscles that circulate the eyes, to the levator muscles that pull the upper eyelids upwards, to the tarsal muscles that provide protection and help raise the upper eyelids. The orbicularis is controlled by the facial nerve, the levator is controlled by the oculomotor nerve and the tarsal muscles are controlled by the sympathetic nervous system.
Spasms occur when these nerves, without a known stimulus, cause contraction of the muscles they control.
Myokemia is the most common spasm that affects eyelids. It can affect either the top or bottom lids but usually only one at a time. These spasms can be very short lasting or go on for weeks and be barely noticeable to very bothersome.
Essential blepharospasms are uncommon, usually without a known cause, and can progress to involuntary bilateral (both sides of the face) orbicularis spasms that may affect other muscles on the face controlled by the facial nerve.
Reflex blepharospasms are spasms created by bright light, ocular surface disease like severe dry eye, and extrapyramidal diseases like Parkinson’s and necessitates a central and peripheral nervous system assessment.
Hemifacial spasms start at the orbicularis muscle and then spreads to the other facial muscles on one side of the face. Neuroimaging may or may not be needed.
Signs and Symptoms |
Signs
Myokemia | Not visible or small contractions of one eyelid. |
Essential, reflex and hemifacial | full facial spasm. |
Symptoms
Myokemia | Very fast eyelid flutter. |
Essential, reflex and hemifacial | Tense facial muscles. |
Causes and Risk Factors |
Causes
Over stimulated oculomotor nerve or facial nerve usually of an unknown cause.
Risk factors
Myokemia | Caffeine, anxiety, fatigue, stress, dehydration, lack of sleep, dehydration, alcohol, multiple sclerosis, myasthenia gravis, ocular surface disease. |
Essential, reflex and hemifacial | Stress, bright light. |
Prevention and Treatment |
Prevention
Journal when the eye spasms occur and try to determine the trigger.
Treatments: there are no known treatments but the episodes can be managed.
Myokemia | Reduce exposure to risk factors, treat underlying conditions. |
Essential, reflex and hemifacial | Talking (can help reset facial nerves), relaxing, treating ocular surface disease, wear tinted lenses, botox, surgery. |
Prognosis |
Episodes of myokemia can be short lived or last many weeks and can come and go randomly. It is not uncommon to be affected with multiple episodes over a period of months but then have the issue resolve and never reccur. The episodes do not cause any damage and therefore there are no known long-term complications.
Essential, reflex and hemifacial spasms may require neuroimaging and nervous system testing. The spasms themselves do not cause damage but the underlying conditions, if not treated appropriately, may worsen.