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botox injections for eyelid twitching and spasms

While most people think of Botox as an injection used for cosmetic purposes, ophthalmologists are interested in the injection’s use as a treatment for eyelid twitching. While most of us experience the annoying sensation caused when our eyelids twitch.  

The majority of the time, this twitching is caused by a lack of sleep and/or stress, and it is only temporary. For some, however, eyelid twitching becomes a chronic situation. This type of eyelid spasming is called blepharospasm 

Figuring Out If Botox Injections Are Right For You

Eyelid twitching will often resolve on its own with a little TLC. If you experience occasional eyelid twitching that happens on and off or that lasts for a day or two, there is a good chance that you are not getting enough sleep and/or that you are under stress.  

Before scheduling an eye appointment, try the following: 

  • Get extra sleep.Are you getting enough sleep? Are you sleeping well once you fall asleep? Visit sleepfoundation.org’s post, How to Sleep Better, and work towards getting the sleep you need to be well-rested. 
  • Practice stress management. Are you under stress? As we go to press, we are still in the midst of the COVID-19 pandemic, and families are struggling with all of the ramifications of that, including distance learning and unemployment. There’s never been a better time to take stock and cultivate the steps necessary to manage your stress. Click Here to read stress management tips from positivepsychology.com. 
  • Minimize or eliminate caffeine.If your spasms are related to a stress response, caffeinated beverages can trigger or exacerbate them. Try to minimize or eliminate caffeine to see if that helps. 
  • Apply a moist, warm compress.If you have the time and space, apply a warm, moist compress (a clean washcloth, folded into fours, and soaked in warm water is perfect) and hold it gently on your eye(s) for five to ten minutes. Repeat as necessary. You can even work this step into your stress management program! 
  • Use artificial tears to keep dry eye at bay.There is a correlation between dry eye and eyelid twitching. Using artificial tears a few times a day can help. If you experience continued episodes of dry eye, it is worth a trip to the eye doctor to evaluate the underlying cause. 

If your eyelids continue to twitch for a week or more, contact your eye doctor – especially if you have any of the following symptoms: 

Other nerve/brain-related issues (Bell’s palsy, MS, Parkinson’s, various dystonias, Tourette syndrome) can also cause blepharospasm, and these should always be ruled out before proceeding with a course of Botox injections. 

There are a few different treatments available to treat chronic eyelid twitching, but Botox injections are the most successful option for patients 12 years old and older. 

Is It Necessary To Treat Eyelid Spasms? 

Some patients find eyelid twitching intolerable, while others find it to be a minor irritation and ask whether they have to treat their spasms at all. We always recommend treating eyelid spasms because chronic spasming can lead to other complications. 

Patients who do not treat long term eyelid twitching risk: 

  • Involuntary eye closure 
  • Light sensitivity 
  • Blurred vision 
  • Uncontrolled winking and blinking 

Patients always have the right to refuse treatment, but we hope that you will schedule an eye appointment and discuss the options at length with your eye care provider before opting to avoid treatment. 

Botox Injections Treat Blepharospasm 

Botox (botulinum toxin) has been an FDA approved as a prescription medicine since 2002 but has been approved for use to treat uncontrolled muscle spasms since 1989. This means patients can feel confident in the 30+ years of safety that backs this treatment option. 

When injected into specific muscles, Botox stops them from contracting – like a relax/cease action solution. In the case of your eyelid(s), we use a very thin needle. This generates a relaxing of the contracted eyelid muscles, and also blocks some of the nerve signaling responsible for the twitching, providing relief from the continuous eyelid muscle spasms. In most cases, patients’ eyelids slow and cease their spasms within a day to a week or so after their injection appointment.  

The appointments only take about 10 minutes per eye or less, and they are almost always covered by your health insurance. Once the Botox takes effect, patients typically benefit from three months of spasm-free vision, at which point they are scheduled for another round of injections. 

If Botox injections are not sufficient enough to relieve the spams, your ophthalmologist will discuss alternative treatment options with you. These may include prescription medication such as clonazepam, trihexyphenidyl, lorazepam, baclofen, and tetrabenazine. However, these medications can have less desirable to downright serious side effects, which is why Botox injections are always our first choice treatment for blepharospasm. 

If neither Botox nor medication is successful, we’ll discuss surgical options which can eliminate the facial muscles or portions of the nerve(s) causing the spasm. 

Risks And Complications Of Botox Injections 

As with any treatment, there are risks and complications associated with using Botox injections. This is one of the reasons you should be very careful when selecting your ophthalmologist. You should work with someone who knows exactly what s/he’s doing, taking the time to review your symptoms, potential causes, and your medical history to ensure this is the right first-step for you.  

Some of the risks and complications associated with Botox injections include: 

  • Problems swallowing, breathing or speaking. This is incredibly rare, and has typically affected those who have had issues with swallowing, breathing, or speaking in the past. This rare side effect occurs when botox affects muscles besides those in the eyelids.  
  • Spread of toxin effects. Again, there is a risk with Botox that the botulism toxin that works on the affected eyelids can potentially migrate or spread to other muscles and nerves, creating a “spread-of-toxin” effect.  

To date, NONE OF THE ABOVE SIDE EFFECTS have ever been associated with patients using botox to treat eyelid twitching. They have only been reported in patients using Botox for cosmetic purposes. 

The ophthalmologists and optometrists here at the Atlantic Eye Institute perform a thorough screening and medical health evaluation, which includes a review of the ingredients found in Botox to avoid an allergic reaction.

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