Eyelid twitching may be a disease, don’t take it lightly!

Author: Chen Guoqiang, Chief Physician of Aviation General Hospital

Reviewer: Xu Jun, Chief Physician, Beijing Tiantan Hospital, Capital Medical University

Our eyelids work very hard because they protect our eyes, so we blink many times a day.

There is a circle of orbicularis oculi muscle around the eyelids that controls blinking. If it is exposed to some adverse stimulation, such as tension or lack of rest, it may cause the muscle nerves to send signals, stimulating the orbicularis oculi muscle to contract and causing the eyelids to twitch.

Of course, for physiological eyelid twitching, when we relax and rest well, the eyelid twitching will gradually get better. But some diseases may cause eyelid twitching, such as hemifacial spasm, which may last for a long time.

1. What is hemifacial spasm?

The facial nerve controls our facial expressions. It starts from behind the ear and has five branches. The top branch is the temporal branch, which controls the levator palpebrae superioris and inferioris. There are also zygomatic branches, buccal branches, mandibular marginal branches, and cervical branches.

Figure 1 Original copyright image, no permission to reprint

Because the nerves in the eyes are very excitable, the early manifestation of hemifacial spasm may be eyelid twitching, and this eyelid twitching often lasts for more than 3 months. When the nerves are transmitted from top to bottom, we can see the patient's facial muscles twitching, that is, the manifestation of crooked mouth, which is medically called hemifacial spasm.

The pathogenesis of hemifacial spasm is that more than 99% of the facial nerve roots in the brain are squeezed and stimulated by blood vessels, causing neuropathy and involuntary twitching of facial muscles. Just like a high-voltage wire, if the skin wrapped around the high-voltage wire is worn away, a short circuit will form, resulting in this problem.

If doctors suspect hemifacial spasm, they usually use electromyography to confirm the diagnosis. For patients who feel that the diagnosis may have been missed, they can also use magnetic resonance imaging to confirm the diagnosis.

Judging from the incidence of hemifacial spasm, its incidence is not low. According to foreign statistics, its annual incidence is about 0.8/100,000. According to foreign statistical data, it is estimated that about 10,000 people in my country suffer from hemifacial spasm every year.

From the perspective of the affected population, it is more common in middle-aged and young people. Children also suffer from hemifacial spasm, but rarely.

2. How to distinguish hemifacial spasm from Meige syndrome?

In terms of the scope of the disease, facial twitching in patients with hemifacial spasm is generally unilateral, and bilateral twitching is very rare, while patients with Meige syndrome generally have symptoms on both sides.

In terms of the first symptoms, hemifacial spasm is usually characterized by intermittent involuntary twitching of the orbicularis oculi muscle or around the lips, which may affect the entire face as the disease progresses. Meige syndrome is usually characterized by bilateral blepharospasm as the first symptom, which may start in one eye and gradually affect both eyes.

In clinical practice, Meige syndrome and hemifacial spasm are easily confused. A patient may have Meige syndrome and hemifacial spasm at the same time. Some epilepsy is facial twitching, which also needs to be differentiated.

There are also some more special patients who have problems with the facial nerve nucleus. Something may grow in the facial nerve nucleus, and finally the face will have a condition similar to hemifacial spasm. It can usually be diagnosed through an MRI examination, so sometimes you have to pay attention to this situation.

Of course, the symptoms of hemifacial spasm and facial paralysis, masseter spasm, including dry eye syndrome, also have some similarities. If related symptoms occur, it is recommended to go to the hospital to find a professional doctor for identification in time to avoid delaying the disease.

3. What are the treatments for hemifacial spasm?

There are three main treatments for hemifacial spasm:

First, oral medication. There is an anti-epileptic inhibitor that can control hemifacial spasm. Many doctors in our country prescribe this medicine to patients, but patients will feel weak after taking this medicine.

Second, inject botulinum toxin. Botulinum toxin can paralyze the facial nerve, usually injected from under the ear to the root of the facial nerve, and can also play a role in inhibiting symptoms related to hemifacial spasm.

Third, surgical treatment. Because hemifacial spasm is mostly caused by vascular compression, only surgical treatment can relieve the compression of nerves and solve the problem from the cause, so surgery is currently the only radical solution.

Figure 2 Original copyright image, no permission to reprint

For patients who have higher requirements for quality of life, such as teachers and taxi drivers, if they are not treated actively, it may affect their classes and driving, so if necessary, they can choose to undergo treatment through surgery.

Generally speaking, nearly 70% of patients can get immediate results through surgical treatment. Of course, because nerves also have a repair process, about 30% of patients recover slowly.

There are also some patients whose symptoms are more severe after the operation than before the operation. In fact, there is no need to be nervous. According to statistics, most patients can recover within a year, and only a few patients take more than a year to recover.

4. What should I pay attention to after hemifacial spasm surgery?

Generally, after surgery, the patient needs to lie down and rest, and cannot drink water within 6 hours;

On the second day, you cannot get out of bed yet, but you should move your legs more often in bed to prevent the formation of deep vein thrombosis in the lower limbs.

If you feel any discomfort when going out on the third day, you should communicate with your doctor at any time because some symptoms are reversible.

For example, if you have early tinnitus, you can take some medicine and it may disappear without affecting your hearing. If you have clear water running from your nose, it may be a symptom of cerebrospinal fluid rhinorrhea, which should also be treated in time. Some patients may also experience headaches on one side and numbness in the head, which can also be treated accordingly under the guidance of a doctor.