Hemifacial Spasm and Blepharospasm

These conditions often are associated with excessive blinking and facial twitching in both or one side of the face. At times, patients may be extremely debilitated when their eyelids clamp shut and cannot open for seconds to minutes. The spasms may be triggered by light, stress, wind, noise, reading, or fatigue.

Women tend to be more affected than men. Most patients are over the age of 50. It can be highly variable with a wide range of affected facial muscles.

Patients may find these spasms extremely difficult to tolerate. Many avoid social situations since the spasms can cause embarrassment and make conversing difficult. Some relief may be gained from lubricating eye drops and sunglasses.

The mainstay of treatment is injection of the facial muscles with botulinum toxin, an example being Botox©. This medication weakens the muscles so that they do not over-contract. The affected muscles are injected with an extremely small needle, leading to minor discomfort that lasts seconds to a few minutes. This treatment often wears off and needs to be repeated on average 4 times per year. Lubricating eye drops and ointments at bedtime may make the eyes more comfortable. It is usually covered by most insurance plans. Treatment of these spasms has often proved to be a signficant change in comfort and confidence level for patients. Dr. Agarwal is an expert in this area and has taught many other doctors in this field. As a board-certified ophthalmologist, she is one of the top users of Botox© in southern California for the treatment of facial spasms.

Facial spasm may also be treated with eyelid surgery. Spasm patients may develop droopy eyelids or other abnormal eyelid positioning including ectropion or entropion. Small outpatient or clinic-based procedures are frequently done by Dr. Agarwal to correct these problems.

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