What are blepharospasms/twitches? Blepharospasm/twitching is an involuntary, abnormal blink or eyelid movement that may occur once every few seconds, sometimes even with the eyes closed. These spasms can last anywhere from a few days to a few months, or they can occur randomly and without warning, and then return quietly without a trace. Although it is not painful, it is rather annoying. For most people, blepharospasm will eventually go away on its own, but sometimes it will reappear. Remember to see an ophthalmologist if: 1) the blepharospasm lasts for more than a week; 2) the eyes close with each eyelid twitch; 3) there is redness, swelling or discharge from the eyes, or a drooping upper lid; or, in rare cases, if there are spasms of facial muscles other than the blepharospasm, the blepharospasm may be an early sign of a chronic movement disorder. Therefore, if twitching or spasms of other facial muscles are noted, it is important to see a doctor as soon as possible for clarification. Causes of Blepharospasm/Twitching Blepharospasm/twitching is usually associated with abnormalities in the basal ganglia, the brain’s muscle movement center. Blepharospasm can occur in anyone, but the cause of each specific blepharospasm is often difficult to identify. Blepharospasm often occurs without warning, and sometimes the twitching subsides or even disappears completely after sleep or distraction. Factors associated with the development of blepharospasm that may aggravate the twitching are as follows: 1) alcohol consumption 2) caffeine 3) fatigue 4) irritation of the ocular surface or inner surface of the eyelid 5) lack of sleep 6) physical overwork 7) smoking 8) excessive stress In rare cases, genetic factors may also play a role in the development of blepharospasm. Blepharospasm may be preceded or accompanied by an eye condition such as blepharitis, dry eye, photophobia, or red eye (conjunctivitis). What is the treatment for blepharospasm/twitching? An eye exam is recommended to look for the cause of the blepharospasm, except for an underlying neurological condition. Although in most cases the cause is not found, a diagnosis of benign idiopathic blepharospasm will be made. Mild blepharospasm often resolves on its own and therefore does not require treatment. Reducing stress, getting more sleep, and drinking less coffee can help relieve the eyelid twitching. There is no cure for blepharospasm, but there are several ways to relieve the level of spasm, the most common of which is to inject botulinum toxin extract into the eyelid muscles, which paralyzes the muscles and reduces the spasm. Therefore, the medication often improves the symptoms after injection, but often requires repeat injections. In more severe cases, myotomy, the surgical removal of part of the eyelid muscle and nerve, may be required. This procedure can improve symptoms in 75 to 85 percent of patients with blepharospasm.