Slight involuntary twitching of the eyelids is common and not usually considered to be of any pathological significance other than being a symptom of fatigue or sometimes of an anxiety state. The condition is termed "myokymia". True blepharospasm is rare. It can be unilateral or bilateral and cause great inconvenience and worry to the patient. It tends slowly to become more marked over many years. A small proportion of patients eventually develops Parkinsonism. Cases of recent onset need to be investigated because they might result from an intracranial space-taking lesion. In most cases, though, no underlying cause can be found. Patients with this type of ble-pharospasm (essential blepharospasm) can often be treated quite effectively by injecting small doses of botulinum toxin into the eyelids, but these need to be repeated every few months.
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