From the FDA Drug Label
to treat certain types of eye muscle problems (strabismus) or abnormal spasm of the eyelids (blepharospasm) in people 12 years of age and older. The best treatment for eyelid twitching (blepharospasm) is botulinum toxin (IM), which is a prescription medicine that is injected into muscles to treat abnormal spasm of the eyelids. 1
- Key benefits: Treatment of blepharospasm in people 12 years of age and older.
- Important considerations: Patients with pre-existing swallowing or breathing difficulties may be more susceptible to complications, and the treatment may weaken neck muscles that serve as accessory muscles of ventilation. 1
From the Research
The most effective treatment for eyelid twitching (blepharospasm) is botulinum toxin (Botox) injections, which should be administered every 3-4 months into the affected eyelid muscles to temporarily paralyze them, as supported by the most recent and highest quality study 2. For mild, temporary cases, reducing stress, getting adequate sleep, limiting caffeine and alcohol intake, and using artificial tears for dry eyes often resolves symptoms. The standard dose of Botox injections ranges from 1.25-5 units per injection site, and this treatment has been shown to improve the severity of contractions with a low rate of side effects, as demonstrated in a 17-year experience with 125 patients 2. In severe cases unresponsive to Botox, oral medications like clonazepam (0.5-1mg twice daily), baclofen (10mg three times daily), or anticholinergics like trihexyphenidyl (1-2mg daily, gradually increased) may be prescribed. Some key points to consider when treating blepharospasm include:
- The importance of addressing underlying factors like eye irritation, dry eyes, or stress to help manage symptoms alongside medical treatments.
- The potential for Botox injections to provide effective relief from symptoms, with a mean interval of relief of spasm of approximately two and one-half months, as reported in a study of 28 patients with mild or moderate cases of benign essential blepharospasm 3.
- The availability of surgical options, such as myectomy or deep brain stimulation, for refractory cases. It is essential to note that while other treatments, such as tonic water, have been proposed as potential remedies for eyelid twitching, there is limited evidence to support their effectiveness, and they should not be relied upon as a primary treatment, as discussed in a review of the proposed pathophysiologic mechanism and safety concerns surrounding tonic water as a treatment for eyelid myokymia 4.