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  • Uncontrolled bilateral, episodic blinking, twitching, or closing of the eyelids (contractions of the orbicularis muscle)
  • Disappears during sleep
  • Meige syndrome: combined with spasms of the lower facial muscles, jaw, and throat area
    • Note: Severe cases can lead to functional blindness, affecting driving capability
  • Sometimes associated with apraxia of lid opening.


  • History: Unilateral or bilateral? Only eyes or also face or the rest of the body affected? Medications?
  • Slit lamp examination: Dry eyes, blepharitis, foreign bodies.
  • Neuro-ophthalmological examination: Any accompanying abnormal findings?
  • For typical blepharospasm: No routine imaging necessary
  • For atypical cases: Neurological consultation


  • treat dry eye / blepharitis
  • In severe cases: Botulinum toxin injections in/around eyelids (in orbicularis muscle)
  • Consider orbicularis myectomy in therapy-resistant patients

Differential Diagnoses

  • Eyelid twitching (fasciculation): Unilateral, very discreet, influenced by dry eyes, stress, caffeine, etc., usually self-limiting.
  • Hemifacial spasm: Unilateral, does not disappear during sleep, may be caused by compression of the facial nerve (MRI!).
  • Surface problems of the eye, dry eye, inflammations
  • Apraxia of Eyelid Opening
  • Tardive dyskinesia
  • Tourette syndrome


  • EyeWiki – Blepharospasm
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Kalla Gervasio MD, Travis Peck MD et al; Lippincott Williams&Wilkins; 8th Edition(2021)
  • Ip C. W. et al., Dystonie, S1-Leitlinie, 2021, in: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. Online: (visited on 10.04.2022)
  • Titi-Lartey OA, Patel BC. Benign Essential Blepharospasm. [Updated 2021 Nov 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: