Summary
Blepharospasm is an uncontrolled, often disabling closure of both eyelids. Hemifacial spasm is an involuntary twitching down one side of the face, including the eyelid. Both are dramatically improved by carefully placed, low-dose botulinum toxin injections, repeated every few months.
This page covers functional botulinum toxin treatment. For aesthetic treatment of frown, forehead and crow’s-feet lines, see cosmetic botulinum toxin.
Who is this for?
Typical patients include:
- people with benign essential blepharospasm, where both eyes squeeze shut involuntarily, sometimes to the point of functional blindness,
- those with hemifacial spasm, often after years of progressive twitching,
- selected patients with Meige syndrome or other related dystonias,
- patients with persistent eyelid twitching (myokymia) that has not settled spontaneously.
A neurology opinion is obtained where the diagnosis or underlying cause is uncertain (for example, to consider neurovascular decompression for hemifacial spasm).
What the procedure involves
Treatment is performed in clinic and takes around 10 minutes. Tiny injections of botulinum toxin (Botox® or equivalent) are placed at carefully chosen points around the eye and, for hemifacial spasm, the cheek. The dose is titrated to your individual response over several visits.
The injections are quick and well-tolerated; most patients describe a brief stinging sensation.
Recovery and what to expect
- Effect begins at 3–7 days and peaks at around 2 weeks.
- Treatment lasts on average 12–14 weeks.
- Avoid rubbing the area for the first few hours.
- Mild bruising at injection sites is common and short-lived.
Risks and alternatives
Risks are uncommon and include temporary lid droop (ptosis), double vision, dry eye and asymmetry, all of which resolve as the toxin wears off. Allergic reactions are very rare.
Alternatives include oral medications (rarely effective), and, for hemifacial spasm, neurosurgical microvascular decompression of the facial nerve.