There are several disorders that cause excessive blinking or severe spasms (marked tightening) of the eyelids.  One of the most common forms is facial tics, also known as benign eyelid fasciculations.  These cause repetitive twitching of the muscles in the eyelids.  Either the upper eyelid or lower eyelid or both can be affected.  They can cause irritation of the eyes or problems with focussing.


In most people these twitches are temporary, lasting a few days or weeks at most, and they resolve on their own.


There are many causes for eyelid tics:


1.  Focusing problems:  These include the early development of presbyopia (loss of near focus at around age 40 that leads to problems with reading ),  or the use of incorrect glasses prescription


2.  Excess use of stimulants, such as caffeine in coffee or tea


3.  Anxiety and stress


4.  Rarely, as part of various neurologic disorders such as Tourette’s syndrome, which affect muscles in various parts of the body





In most cases, the eyelid twitches are temporary.  However, if they are longstanding or recur frequently over a few weeks, then an underlying cause should be looked for and treated if found.  Reduction of caffeine intake may be necessary if it is a factor.  A thorough eye examination will detect any problems with focusing that might require glasses.


If no intervention is indicated or treatment of an underlying cause is not successful in relieving the eyelid tics, then injection of small amounts of Botulinum Toxin into the twitching eyelid muscles can relieve the problem. There are two botulinum products approved for use in Canada, BotoxTM (licensed by Allergan, Inc.) and XeominTM (licensed by Merz Pharmaceuticals), and they are equally effective in treating these condition.


BotoxTM  and XeominTM are safe agents for treating these eyelid problems.  Since very tiny doses are used there are no body (systemic) side effects expected.  If the lower eyelid muscle is relaxed too much, the patient may experience tearing due to overflow of tears out of the eye, or drying of the eye due to exposure.  Dryness can be controlled with artificial tears supplements during the day.  These problems resolve within 2 to 4 weeks as the eyelid muscles recover some of their power.  In the upper eyelid there is a very small chance of spread of the drug into the deeper eyelid muscle which can cause a temporary droop of the eyelid (“ptosis”), and this will recover over 2 to 6 weeks.