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Blepharospasm and Hemifacial Spasm

Little Rock Oculoplastic & Facial Cosmetic Surgeon


Is your eyelid twitching?! This is most likely due to myokymia (simple eyelid twitches) that most people experience from one time or another. They may occur intermittently for a few days but occasionally can last over a month.

Usually they will improve with time, rest and relaxation or decrease in caffeine intake. When they are persistent or encroaching on your peace of mind, then neuromodulators such as botox or xeomin.

Difference Between Blepharospasm and Hemifacial Spams

Blepharospasm and hemifacial spasm are more problematic than myokymia. Blepharospasm is a movement disorder arising from your central brain cortex. Cervical dystonia and Parkinson’s disease are other examples of movement disorders. Hemifacial spasm is consists of spasms of the facial muscles on one side of the face; this is caused due to an enlarged vein or other vessel abutting the facial nerve near it’s exit from the brainstem creating irritation of the nerve.

There are other distinct differences between blepharospasm and hemifacial spasm as well as some similarities. When patients have blepharospasm it is often of a slow onset. Blepharospasm is a bilateral problem; that is, it effects both sides. Sometimes lower facial muscles may be involved (Meige syndrome). Blepharospasm typically does not keep a person from falling asleep or wake them up. Sometimes patients with blepharospasm also experience apraxia of eyelid opening. This means, that at times, the eyelids will uncontrollably clamp shut for 1-5 seconds or more and cannot be opened. Imagine trying to flex your arm with your bicep at the same time you extend your arm with your tricep; this may give you some insight into how it feels to try to open your eyes when they are uncontrollably clamped shut.

Hemifacial spasm typically affects one side of the face; however, there can be cases of bilateral hemifacial spasm. Spasms from hemifacial spasm can keep patients awake or awake them from sleep.

When To Expect Results

Although treatments were very limited and less than satisfactory 30 years ago, we are now able to alleviate symptoms of blepharospasm and hemifacial spasm with neuromodulators. These are administered as small injections into the affected muscles. The neuromodulator is a purified protein that binds to receptors blocking communication between your nerves and their paired muscles. The effects usually begin as soon as 48 hours. The peak effects are from 7- 30 days, but very effective relief continues typically for 3-4 months.

There are surgical options for blepharospasm and hemifacial spasm also, but they are usually reserved for less common instances when the neuromodulators do not deliver the desired relief. The surgery reserved for blepharospasm is called a myectomy. With a myectomy, the muscles around the eye that create closure are meticulously excised. The surgery used for hemifacial spasm is a neurosurgery, or intracranial surgery, where a small piece of Teflon is placed between the offending vessel and vein. Although Dr. Brock is experienced in myectomies for blepharospasm, referral to a specialized medical center is necessary for surgical treatment of hemifacial spasm.

What will your treatment be like?

Dr. Brock evaluates your pattern of spasms. He will illustrate for your where he believes you will benefit from neuromodulator injections. You will sign a consent for him to proceed with treatment. The treated areas will be prepped with an alcohol pad and injected with a small caliber needle. Most patients report some mild discomfort, but agree that the relief they receive is worth it. Expect to have some small bumps at the point of injection for a couple of hours. Some bruising may occur. Immediately after treatment, it is recommended that you do not get extremely hot, perform vigorous activities or sleep on one side exclusively for the next 48 hours; these activities sometimes correlate with having a droopy eyelid. The risk of ptosis (droopy eyelid) is 2% for every treatment. The risk is slightly higher if you already have a ptosis. If Dr. Brock is treating you for the first time, he will arrange to see you approximately 2 weeks after your first treatment; he can then determine if he should treat some areas further or less in the future and whether he needs to alter any locations of the injections. The results will be duplicated most of the time, so once you and Dr. Brock are using a pattern and amount of neuromodulator that is effective, he will not require you to return until your next treatment in several months. Neuromodulators do not offer a perfect result or cure; however, they are a gift, providing a significant amount of relief that would otherwise be unavailable.

Why You Should Choose Dr. Brock

Dr. Brock will introduce you to the blepharospasm foundation. This foundation supports research and patients with blepharospasm and hemifacial spasm. The foundation provides a significant amount of education and offers you the opportunity to participate in a community of scientists, physicians, and patients who are understanding and passionate about support and providing relief to affected patients. You can rest assured that you are in the very best of hands to treat your blepharospasm or hemifacial spasm. Dr. Brock has been published in the quarterly newsletter of the foundation. He has also lectured locally and outside of our state regarding blepharospasm, hemifacial spasm and their treatment. More importantly he offers you his experience of having provided treatment to hundreds of patients per year for more than 15 years. If you or a friend have blepharospasm or hemifacial spasm and are in need of relief, reach out today for treatment by calling our office at 501.223.2244. We’re here for you!

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Dr. Brock did my orbital decompression surgery and did an outstanding job. He is caring, compassionate and very professional. I would recommend him in a heartbeat. Thanks Dr. Brock for everything and for helping me get my life back.

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  • Blepharospasm: It refers eyelid muscles around the eye which close involuntarily. This may cause loss of vision, especially while reading, headaches, and eyebrow strain. The early symptoms of blepharospasm include increased blink rate (77%), eyelid spasms (66%), eye irritation (55%), midfacial or lower facial spasm (59%), brow spasm (24%), and eyelid tic (22%).
  • Ptosis: Ptosis is also known as Blepharoptosis. It refers to an eyelid which is droopy. This may cause a loss of vision, especially while reading, headaches, and eyebrow strain.

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