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Blepharospasm Management

Botox For Eye Twitching And Eyelid Spasm (Blepharospasm)

If you experience uncontrollable and increased blinking or involuntary eyelid movement in the form of twitching or closing, you may be suffering from blepharospasm. Botox injections are commonly prescribed to manage the symptoms of blepharospasm in Singapore.

While disruptive, blepharospasm is generally not considered life threatening on its own, but it can restrict your daily activities or expose you to hazardous situations; Depending on the severity of the condition, blepharospasm can cause mild visual impairment to temporary blindness, increasing the risk of accidents occurring when you are:

  • Walking or running
  • Handling equipment (Eg. Power tools or kitchen equipment)
  • Driving

Botox for blepharospasm management

While there is not cure for blepharospasm, Botox injections are often recommended for managing or alleviating the symptoms of the condition due to the ability of botulinum neurotoxin to cause muscle paralysis.

The Clifford Clinic is an aesthetic clinic that offers Botox injections for the treatment of various aesthetic and medical conditions. This service page focus on the use of Botox for treating eyelid spasms, if you are interested in the other applications of Botox, please read our service pages on Botox treatment for cervial dystonia, jaw Botox, or Botox for wrinkle treatment

What to expect during a Botox session at The Clifford Clinic

Botulinum neurotoxin (BoNT) is a neurotoxic protein produced by the Clostridium botulinum bacterium that causes flaccid paralysis (muscle weakness/reduced muscle tone). BoNT is most well-known for its medical and cosmetic use as an injectable paralysing agent and muscle relaxant.

Before prescribing Botox treatment, our clinic’s doctor(s) will first assess your condition via a pre-treatment consultation session to determine if you are suffering from blepharospasm and/or how severe your symptoms are if you have been diagnosed with blepharospasm to ensure that you are fit for receiving Botox injections.

On the treatment day, our doctor(s) will mark out specific points on the treatment area prior to performing the injections.

Once the injection points are finalised, Botox units will be carefully injected to minimise discomfort.

The Botox painful?

As the skin around the eyes is delicate, topical numbing cream will be applied before the treatment begins.

However, depending on how sensitive the patient’s skin is, some patients may still experience a brief moment of discomfort (often described as a pin prick or a sharp stinging sensation akin to a bee sting) at the time of the injection.

What is blepharospasm?

Blepharospasm is a term used to describe abnormal or involuntary contractions of the muscles in or around the eyes (orbicularis oculi). Eyelid spasms, eye twitching, and eye dystonia are other common terms used in reference to this condition. Symptoms of blepharospasm typically present gradually and can potentially worsen over time.

Mild blepharospasmModerate blepharospasmSevere blepharospasm
  •       Mild twitching
  •        Occasional increased blinking
  •        Stronger/more prolonged twitching
  •    Frequent rapid blinking
  •  Sensitivity to light
  •  Difficulty performing daily activities
  •  Persistent, frequent, and/or prolonged uncontrollable closure of the eyelids
  • Functional blindness

Depending on the type of blepharospasm the patient is suffering from, symptoms can be temporary, resolving on their own after a few days or weeks, or chronic, constantly recurring/persisting over a long period of time. Signs of blepharospasm include:

  • Sensitivity to light
  • Dryness of the eyes
  • Involuntary excessive blinking (can be observed as rapid increased blinking)
  • Prolonged involuntary closure of the eyelids
  • Synchronized (both eyes are affected) eyelid spasm/twitching caused by uncontrollable eye muscle contractions
    • The twitching can spread to the nose, face, cheeks, and neck in severe cases
    • The twitching experienced is usually patterned/non-random; Blepharospasm twitching has a “rhythm” that trained healthcare professionals are able to identify

Symptoms of blepharospasm are progressive and the severity of the condition can potentially worsen over time; Symptoms can start out mild like occasional eyelid twitching or slightly excessive blinking but progress into persistent blinking that results in visual impairment or functional blindness.

Types of blepharospasm

There are two types of blepharospasm: benign essential blepharospasm (BEB) and secondary blepharospasm.

Benign essential blepharospasm (BEB)

Also known as primary blepharospasm, BEB is a neurological movement disorder (focal dystonia) that causes involuntary muscle contractions. While the exact cause of BEB is unknown, there are several risk factors that are linked to the development of BEB:

Aging – Age of onset is typically around 50 to 70 years of age.

Genetics – Around 20-30% of patients who suffer from BEB have a biological family member who also has the condition.

Gender – Women are likely to develop BEB than men. Women with BEB are also more likely to suffer from more frequent and/or severe eye twitching/spasms compared to men with BEB.

Stress and poor mental health – Stress or conditions such as depression, anxiety, or obsessive-compulsive disorder (OCD) are linked to BEB.

Fatigue – Fatigue can increase a patient’s susceptibility to developing BEB.

Injury – Patients with past or current injuries to their eye(s) or nervous system are more likely to develop BEB.

Secondary blepharospasm

Blepharospasm caused by outside (secondary) factors and can be spontaneous or caused by underlying medical conditions. Possible causes of secondary blepharospasm include Tourette syndrome, Meige’s syndrome, Parkinson’s disease, and medications used to treat Parkinson’s disease.

Reflex blepharospasm is a subset of secondary blepharospasm caused by irritation to the eye. Dry eye syndrome, ingrown eyelashes, corneal abrasion (damage to the cornea), internal inflammation of the eye, and eyelid inflammation are contributing factors of reflex blepharospasm.

Blepharospasm vs myokymia

Blepharospasm is often confused with ocular myokymia (also known as eyelid myokymia) due to similarities between the symptoms of mild blepharospasm and myokymia.

 BlepharospasmOcular myokymia
  • “Rhythm” twitching/ spasms
  •  Excessive blinking
  • Prolonged involuntary eyelid closure
  •  Sensitivity to light
  • Dry eyes
  • Eyelid twitching/ spasms in the form of sporadic pulsing
Area affected
  • Usually bilateral
  •  Periocular (area around the eye)
  • Usually unilateral
  •  Usually lower eyelid (but can occur in the upper eyelid)
  • Botox injections
  • Oral medication
  • Surgery
  • Botox injections
  • Stress reduction
  • More sleep

How is Blepharospasm diagnosed?

Blepharospasm is typically diagnosed clinically via a medical physical exam, however, diagnostic tests such as a magnetic resonance imaging (MRI) scan or an electromyography (EMG) study are occasionally done to confirm a diagnosis or to rule out other medical conditions with symptoms that resemble blepharospasm.

What to expect during my pre-treatment consultation session at The Clifford Clinic?

During the consultation session, our doctor(s) will conduct a physical exam that involves:

  • Recording your blinking frequency
  • A blink reflex test
  • An eye examination
  • A facial muscles examination

In addition to the physical exam, our doctor(s) may also enquiry about your medical history, the medical history of your family, onset date of your symptoms, the severity of your symptoms, and/or the triggers of your symptoms.

If you suspect that you suffer from blepharospasm or would like to find out more about blepharospasm treatment, please do not hesitate to drop us a call or book a consultation appointment with our doctors at The Clifford Clinic, Singapore.


Slight discomfort or mild pain can be expected during the injections. Topical numbing cream will be applied to minimise discomfort during the injections if desired.

Patients are typically able to resume daily activities immediately after all Boto treatments we offer as there is minimal to no downtime after Botox injection treatments. However, you may experience mild swelling or redness of the treatment area for a few hours post injection.

Relief from symptoms are typically experienced immediately after the first injection or within the first week post treatment by most patients. Twitching/spasms should continue to subside over the 4 weeks after the Botox injection(s)

Effects are not permanent but will last typically between 6 to 12 months, depending on how quickly your body breaks down the drug.