Eye Twitching for Weeks? Blepharospasm and Hemifacial Spasm

Eyelid twitching that keeps going for more than a few weeks is one of the National Eye Institute's reasons to see an eye doctor, along with twitching that closes your eyes completely or spreads to other parts of your face. It can still be the everyday kind that keeps getting set off, but two less common conditions cause twitching that won't stop. Blepharospasm makes both eyelids blink or squeeze shut on their own, and hemifacial spasm twitches one side of the face, usually starting around the eye. Blepharospasm stops during sleep, while hemifacial spasm can go on. Botulinum toxin injections are the main treatment for both.

Key takeaways

Twitching for weeks may come from the less common blepharospasm or hemifacial spasm, or it may be the everyday kind with a trigger that hasn't let up.
Blepharospasm makes both eyelids blink or squeeze shut and stops during sleep, while hemifacial spasm twitches one side of the face and can continue during sleep.
Botulinum toxin (Botox) injections are the main treatment for both, usually repeated every 3 to 4 months for blepharospasm and every 3 to 6 months for hemifacial spasm.
Call 911 for sudden drooping or numbness on one side of the face, arm weakness, trouble speaking, double vision or loss of vision, even if it goes away.

Why does my eye keep twitching for weeks?

A twitch that lasts for weeks may be the everyday kind with a trigger that hasn't let up, a side effect of a medicine, or one of two less common conditions, blepharospasm and hemifacial spasm.

The everyday kind, myokymia, is a minor, occasional twitch, and it may keep returning while triggers such as stress, dry eye, caffeine and short sleep continue.

Twitching can also be a side effect of certain medicines, or part of other conditions such as Parkinson's disease, Meige syndrome and Tourette syndrome. If the twitch began after you started a new medicine, tell the doctor who prescribed it.

Dry eye deserves a look when the twitch comes with irritated eyes. In blepharospasm, eye dryness is one of the most common accompanying symptoms.

Is it blepharospasm or hemifacial spasm?

Two features tell them apart: which side of the face is involved, and whether the spasms stop during sleep. The table draws on StatPearls reviews of benign essential blepharospasm and hemifacial spasm, and on the blepharospasm pages of the National Eye Institute and MedlinePlus Genetics.

Feature	Blepharospasm	Hemifacial spasm
Side	Both eyes, at the same time	One side of the face
How it starts	More blinking, eye discomfort or eyelid fluttering	Brief closures of one eye, spreading to the lower face over months to years
During sleep	Stops	Can continue
Usual cause	The part of the brain that controls the eyelid muscles stops working correctly	An artery pressing on the facial nerve
Who gets it	Adults in mid to late life; women more than twice as often as men	Adults, often in their 30s to 50s; women about twice as often as men
Main treatment	Botulinum toxin injections every 3 to 4 months	Botulinum toxin injections every 3 to 6 months; surgery can address the cause

What is blepharospasm?

Blepharospasm is blinking or other eyelid movements, like twitching, that you can't control. It is a type of dystonia, a group of movement disorders in which muscles tense up on their own, and it is the second most common type of focal dystonia.

It usually starts with small eyelid twitches every once in a while. Over time the twitching can come more often and close the eyes completely, which makes reading or driving hard. When the lids clamp shut often enough, a person can't rely on their sight even though the eyes themselves are healthy, a complication called functional blindness.

In some people the spasms spread to other muscles of the face, and when the jaw and tongue are involved too, the combination is called Meige syndrome.

It happens when the part of the brain that controls the eyelid muscles stops working correctly, but in most cases doctors aren't sure what causes that. An eye doctor can check for it during a comprehensive eye exam, along with your medical and family history. Brain imaging is usually unnecessary unless the pattern is unusual.

What is hemifacial spasm?

Hemifacial spasm is involuntary twitching of the muscles on one side of the face, the muscles controlled by the facial nerve, also called the seventh cranial nerve.

It classically starts with brief, painless closures of one eye. Over several months to years it spreads to muscles of the lower face, and the contractions can continue during sleep, which sets it apart from most movement disorders.

Most often, an artery presses on the facial nerve as the nerve leaves the brainstem. Less often, a benign tumor pressing on the nerve, an injury or a multiple sclerosis plaque in the brainstem is responsible, so a brain MRI is the main test to rule out a structural cause.

How are blepharospasm and hemifacial spasm treated?

Botulinum toxin injections are the main treatment for both blepharospasm and hemifacial spasm. For blepharospasm, they reduce the uncontrolled muscle movements, and relief typically begins a few days after treatment and can last for several months.

For blepharospasm, most people need injections every 3 to 4 months. The FDA label for Botox covers blepharospasm associated with dystonia, including benign essential blepharospasm, in people 12 and older. For hemifacial spasm, the effect usually lasts 3 to 6 months, and injections are repeated on that schedule.

Surgery is also an option. For blepharospasm that injections don't control, a myectomy removes some of the muscle or nerve tissue from the eyelids. For hemifacial spasm, microvascular decompression frees the facial nerve from the vessel pressing on it. It is the only treatment that addresses the cause, and its risks include facial weakness and hearing loss.

Care for the eye surface helps too. Preservative-free artificial tears, lubricating ointments, warm compresses, eyelid hygiene and treatment for meibomian gland dysfunction are part of managing blepharospasm. Blinking less after injections can leave the cornea, the clear front of the eye, exposed and lead to sores on its surface, especially in people with facial nerve disorders.

When is eye twitching an emergency?

When it comes with signs of a stroke or another nerve emergency. Call 911 if one side of your face suddenly droops or goes numb, or if you suddenly have arm weakness, trouble speaking, loss of balance, double vision or loss of vision, even if it goes away. For sudden blur on its own, call us and come in for an exam if it clears right away, or go to an emergency room if it doesn't.

A droopy eyelid with the twitch needs a look too. A droop that appears suddenly needs a same-day visit (call 310-828-2010), or an emergency room when we're closed; our droopy eyelid page covers the other causes. A droop that comes with double vision, a pupil that looks different, eye pain or a severe headache needs 911.

For twitching without those signs that lasts for weeks, closes your eyes or spreads across your face, book an eye exam.

How we check a twitch that won't stop at Cohenmehr Optometry

For a twitch that has lasted weeks, start with a comprehensive eye exam: the slit lamp shows whether dry eye is part of the problem, and our dry eye evaluation adds imaging of the eyelid oil glands when it is.

When the spasms point to blepharospasm or hemifacial spasm, our Los Angeles eye doctors arrange the referral to an ophthalmologist, send your records, and keep treating any dry eye alongside the injections.

Our eye symptoms guide sorts other eye complaints by how soon they need care.

Questions patients ask

Can stress make blepharospasm worse?

Yes. Stress and exhaustion are among the triggers people with blepharospasm name most often, along with wind and long stretches of screen time. Many also find a trick that eases a spasm for a moment, like touching the brow or temple. Managing stress, getting enough sleep and cutting down on caffeine may help.

Can Botox for blepharospasm cause a droopy eyelid?

It can, usually for a short time. Common side effects of botulinum toxin injections for blepharospasm include a temporary droopy eyelid, trouble closing the eye fully, worse dry eye and bruising. Tell the doctor who gave the injections about these. Call 911 for sudden double vision or trouble swallowing, speaking or breathing: the Botox label warns that the toxin's effect can spread beyond the injection site, and that swallowing and breathing problems can be life threatening. If a droop appears suddenly without a recent injection, our droopy eyelid page explains when it's urgent.

Can Bell's palsy cause eye twitching?

It can. Hemifacial spasm, twitching on one side of the face that usually starts around the eye, can be a late effect of Bell's palsy. While the palsy lasts, the eyelid on that side can be hard to close, which dries the eye, and lubricating eye drops help keep it moist; our page on Bell's palsy and the eye explains how to protect it at night.

Is photophobia a sign of blepharospasm?

It can be. Half of people with benign essential blepharospasm have other eye symptoms, most often dryness and photophobia (sensitivity to light), and an FL-41 lens tint has been shown to reduce that photophobia. Light sensitivity has many causes, though, and light that suddenly bothers you, especially with eye pain or redness, needs a same-day exam, or an emergency room when we're closed. Among the first signs of blepharospasm are more frequent blinking, dry eyes and eye irritation made worse by wind and sunlight.

Is blepharospasm genetic?

Genes are almost certainly involved, but most people with blepharospasm have no family history of it. Most cases are sporadic, meaning they occur in people with no relatives who have blepharospasm or another dystonia. Less often it runs in families, yet no gene has been clearly linked to it, and a mix of genetic and environmental factors is the likely cause.

Sources

Written by

Dr. Kevin Cohenmehr, OD

Medical eye care: glaucoma, diabetic eye exams, macular degeneration and eye infections, plus vision therapy for children. A graduate of UCLA and SUNY College of Optometry.

About Dr. Kevin →

Eye Twitching for Weeks: Could It Be Blepharospasm or Hemifacial Spasm?