When eye twitching doesn't stop: Understanding facial muscle spasm and treatments available

Straits Times

13-05-2025

A subtle eye twitch could be the first sign of hemifacial spasm which can spread to the rest of your face. PHOTO: GETTY IMAGES
BRANDED CONTENT When eye twitching doesn't stop: Understanding facial muscle spasm and treatments available A persistent eye twitch may be an early sign of hemifacial spasm, a progressive neurological condition. Specialist neurosurgeon Dr Nicolas Kon explains how timely treatment can halt its progression
Most of us have experienced an occasional eye twitch – often stress-related and fleeting. But when that persistent eye twitching becomes frequent or spreads across the face, it could signal hemifacial spasm (HFS), or facial muscle spasm, a neurological condition that is marked by involuntary muscle contractions on one side of the face.
Dr Nicolas Kon, a hemifacial spasm specialist at Neuro Asia Care, explains: 'The spasms typically begin around the eye and may extend to the cheek, mouth and jaw. In most cases, it is caused by a blood vessel pressing against the root of the facial nerve, disrupting its function.
'As the protective layer of the nerve wears down from this constant contact, abnormal signals are sent to facial muscles which trigger the involuntary twitching and spasms patients experience.'
There are two types of spasms: clonic spasms are fast, repetitive twitches, while tonic spasms cause prolonged tightness in the facial muscles. 'Although brief, these episodes can occur frequently and interfere with daily life,' adds Dr Kon.
Hemifacial spasm affects about 15 in 100,000 people and is seen more often in Asian populations. INFOGRAPHIC: NEURO ASIA CARE
Beyond the physical discomfort, HFS can impact daily life significantly. Activities like reading, driving, or watching TV may become difficult when the eye closes involuntarily. Over time, the unpredictability and visibility of the spams can erode one's confidence, interfere with work and social interactions, contributing to a reduced quality of life, explains Dr Kon.
Diagnosing hemifacial spasm
A persistent, one-sided eye twitch is often the first sign of HFS. If the eye twitch begins to spread or intensify, evaluation by an HFS specialist is recommended. Diagnosis typically includes a physical exam followed by a specialised magnetic resonance imaging or MRI scan to assess whether a blood vessel is compressing the facial nerve and to rule out other conditions such as tumours.
Studies show that hemifacial spasm affects about 15 out of every 100,000 people, and appears to be more common among Asian populations. According to Dr Kon, there is no official data for Singapore, but the numbers are likely to be similar. Many cases may go undiagnosed especially when the milder symptoms are dismissed as fatigue or stress.
'Women, especially those in their 40s to 60s, are more commonly affected, with a higher frequency of symptoms occurring on the left side of the face. These demographic patterns underscore the need for awareness and tailored treatment approaches in our region,' adds Dr Kon.
Treating hemifacial spasms with microvascular decompression
There are three primary treatments for HFS:
Oral medication , which may provide temporary relief in early stages but often loses effectiveness over time.
, which may provide temporary relief in early stages but often loses effectiveness over time. Botulinum toxin injections , which provide temporary relief by relaxing the affected muscles, but need to be repeated every few months.
, which provide temporary relief by relaxing the affected muscles, but need to be repeated every few months. Microvascular decompression (MVD), a one-time procedure that addresses the root cause and offers long-term relief.
'MVD offers a long-term solution for HFS as the procedure directly addresses the root cause – the pressure on the facial nerve,' says Dr Kon.
Performed under general anaesthesia, MVD involves making a small incision behind the ear to access the affected area. A cushion-like pad is then accurately placed between the facial nerve and the compressing blood vessel.
'This accurate placement and repositioning help alleviate the pressure that triggers the facial spasms,' Dr Kon explains.
Patients can choose from three treatment options, depending on their condition and what best fits their lifestyle. INFOGRAPHIC: NEURO ASIA CARE
According to Dr Kon, this is a minimally invasive procedure and most patients stay in hospital for only a few days. Recovery typically involves avoiding strenuous activities like heavy lifting for a month, but patients tend to notice an immediate improvement.
'In my practice, 90 per cent of patients achieve complete relief after MVD surgery. Many patients become spasm-free immediately after surgery. In more severe cases, spasms may take up to several weeks to subside,' says Dr Kon.
Although risks like temporary facial weakness or hearing loss exist, these are uncommon, and quality of life improves significantly, adds Dr Kon.
Dr Kon notes that most of his patients experience complete relief after undergoing MVD surgery. INFOGRAPHIC: NEURO ASIA CARE
MVD is a one-time procedure for most, and is recommended for patients with clear signs of nerve compression, good overall health and symptoms that persist despite other treatments.
MVD may not be suitable for everyone – especially those with mild symptoms or who are medically unfit.
'A personalised approach is essential,' says Dr Kon. 'Whether your goal is symptom relief, reducing eye strain and discomfort, or feeling more confident in social settings, the treatment plan should align with your lifestyle and medical needs.'
To learn more about hemifacial spasm, MVD procedure or consult with Dr Nicolas Kon, visit the Neuro Asia Care website.
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