How Does Blepharospasm Differ From Hemifacial Spasm?

If you are suffering from a facial twitch, various things might be causing it. However, it is possible that a serious nerve issue could be the underlying cause, which may require surgery or other interventions to treat effectively.

Among the conditions with a neurological cause are blepharospasm and hemifacial spasm. As the names suggest, both involve muscle spasms, but they are not one and the same thing, and there are ways of distinguishing them and providing the appropriate treatment.

Blepharospasm is centred on muscle spasms of the eyelid muscles, principally the orbicularis oculi muscle, which controls the closing of the eye.

While your eyes naturally close and stay closed for hours while asleep (notwithstanding the rapid eye movement that occurs when you are dreaming), this condition involves involuntary contractions that lead to excessive and uncontrolled twitching and blinking.

What Are the Different Types Of Blepharospasm?

Blepharospasm exists in two forms, primary and secondary. In the latter case, it can be an additional feature of another condition, such as Meige Syndrome, Parkinson’s Disease or a reaction to some medications.

Primary blepharospasm, which is also sometimes known as benign essential blepharospasm, is not believed to stem from one single cause, but from a range of factors, including genetic, environmental and functional factors. The last of these can include facial nerve compression, which is why surgery can be an effective blepharospasm treatment.

Other symptoms include:

• Tearing
• Dry eyes
• Sensitivity to bright light
• Blindness (this is rare)

Sufferers from blepharospasm come from both genders and different ages, but it most commonly appears in women and affects patients in middle age.

How Does Hemifacial Spasm Differ From Blepharospasm?

Hemifacial spasm is a similar condition because it also involves facial muscle spasms, but while it might be conflated with blepharospasm, it is different and a correct diagnosis will distinguish between the two.

A hemifacial spasm is characterised by involuntary muscle movements on one side of the face. These can be confused with blepharospasm because they tend to start around one eyelid, but they tend to extend to affect the cheek and sometimes one side of the mouth.

The causes of hemifacial spasms are similar, but not quite the same, as those of blepharospasm and centre on the facial nerve. This is often a blood vessel pressing on it, while a tumour may also do so and a facial nerve injury is another possible cause.

These differences mean the conditions, while similar in cause and symptoms, are sufficiently different to be fully distinguished and the treatment is as well. This is where a correct diagnosis is important so that the correct course of treatment can be planned.

How Is Blepharospasm Treated?

For blepharospasm, the treatment will depend partly on whether it is primary or secondary. The former can be treated in several possible ways:

• Botox, which is injected into the eyelid muscles to relax them and prevent them from spasms and contractions. The treatment lasts for three to four months, but may become less effective over time
• Stress management combined with reduced caffeine and better sleep
• Tinted lenses, which can help those whose condition is triggered by bright lights
• Medication by diazepam or lithium, although this does not work for everyone, as sometimes they are not very effective and side effects can be significant
• Surgery to thin the eyelid muscles by removing muscle or nerve tissue

A hemifacial spasm might be treated rather differently, with work to decompress the nerve or vascular blood vessel (if that is what is causing the issue). Sometimes, this might also be treated with Botox to prevent muscle spasms.

Clearly, if the cause is a tumour, that will require a wholly different kind of intervention, such as surgery to excise the tumour, or the use of radiotherapy to shrink a tumour or prevent its recurrence after surgery.

How Can We Help You?

Blepharospasm and hemifacial spasm are different but similar conditions and the key point in understanding the difference is the causation. Both may have simple primary causes, such as an issue with the nerves or muscles themselves, or be the secondary result of something else that is of concern in its own right, such as Parkinson’s Disease or a tumour.

In either case, an accurate diagnosis to determine which of these you have is just the start. In consultation with our experts, you can chart a path forward based on the treatment chosen, which may involve a one-off surgical procedure or repeated treatments like Botox. We can also help if the treatments you have tried so far have been ineffective.

What you can be sure of is that with these conditions, just as with any other medical issues we treat, you will be treated as an individual and your treatment will be tailored to your own specific needs and circumstances.

Learn more about our advanced neurosurgical treatments for Blepharospasm on the Queen Square website.