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A constant throbbing or pulsating twitch around your eye can be, to put it mildly, very distracting. It can interfere with your vision, your concentration, your conversations, and your sleep. There are a number of possible causes of twitches under the eyes, some easier to treat, and some that can't be beat without a doctor's help:

Benign essential blepharospasm is a constant twitch of an eyelid. Doctors used to think it was a psychological problem. Now it is known to be a neurological problem, but it's not related to a lesion in a specific place in the brain. Instead, it's a problem with a nerve circuit that keeps the brain from processing visual information that would squelch the blink reflex. It's as if your eye "wants" to blink, but can't quite do it. However, since the "stop-blinking" circuit in the brain isn't working efficiently, the eye becomes more likely to blink due to dryness, allergies, stress, pain, infection, irritation, or inflammation. 

This kind of annoying twitch isn't just due to aging or injury to the brain, and it isn't just due to various kinds of insults to the eye such as the dryness, allergies, stress, pain, infection, irritation, and inflammation mentioned above. It's a combination of two or more problems that causes the blepharospasm, and often treating just one of them stops the twitch.

Benign essential blepharospasm may just cause you to blink a lot. You might unconsciously bat your eyelashes, which can lead to some interesting social interactions. (Guys, this isn't a problem you want to have in a locker room. Unless you do.) At the other extreme, this condition can cause severe eye pain and even blindness, so that you have to give up watching TV, reading, driving a car, or your job. You aren't likely to get all of the symptoms of the disease at once:

  • 77 percent of people with benign essential blepharospasm have increased blink rate.
  • 66 percent have eyelid spasms.
  • 59 percent have spasms lower on the face.
  • 55 percent have eye irritation.
  • 24 percent develop eyebrow spasms.
  • Only 22 percent develop eyelid tics.

However, all of these problems have the same underlying cause. Their effect can be very serious. People may develop social anxiety (especially if they send romantic signals without realizing they are sending them), become depressed, and withdraw from life, in some cases.

Blepharospasm is more common after the age of 55, although it can occur at any age, and a little less than twice as common in women as in men.

What can be done for this condition?

  • Tinted lenses are a must if photophobia (sensitivity to light )is a problem.
  • Getting more sleep helps in 75 percent of cases. Taking time off from work or simply leaving work on time helps in 55 percent of cases.
  • Mild cases are sometimes corrected by using Liquifilm tears. These bring relief about 24 percent of the time.
  • Inferior gaze, looking downward at objects below eye level, for a few minutes at a time a few times a day, helps in about 27 percent of cases.
  • Some (about 20 percent) of people with the condition get relief by talking, singing, or humming.
  • Doctors used to treat this condition by taping up the eyelids, but the tape is not tolerated very long and the method is not particularly effective.
  • Botox injections may stop the twitching, but there are possible side effects, like having a lazy eyelid for a few months while the injection wears off. The more often you are treated, the more complications you will have. Most patients have serious side effects by the time they have had four injections.
  • Medications for Parkinson's disease (L-dopa, also known as Artane) and anxiety (especially the tranquilizer lorazepam) can help, but also have side effects.
  • In extreme cases, eyelid surgery may be the answer, but try every other possible treatment first.



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