Blepharospasm refers to the forceful involuntary closure of the eyes. Blepharospasm sufferers are unable to keep their eyes open when they want to. They may complain of sensitivity to light and general eye discomfort. The sufferer often appears to be suffering from a facial tic or twitching.
Blepharospasm is a very uncommon condition, usually affecting people in the 50s or older. It is commoner in women than men.
Blepharospasm sufferers often find that blepharospasm varies in severity during the day being better in the morning and worse later on in the day. Stress may provoke it. It can be worsened by bright light and any condition which causes ocular irritation e.g. dry eye conditions. In the vast majority of patients, the condition tends to be life long, although in some the condition spontaneously resolves.
The cause of blepharospasm is unknown. Some researchers think that the problem may lie with a parts of the brain which are responsible for movement regulation. Blepharospasm is thought be a localised form of dystonia.
Hemifacial spasm is a condition characterised by involuntary twitching and contractions of the muscles on one half of the face. Like blepharospasm, it can be concentrated around the eye but generally tends to be be more diffuse affecting the muscles in the lower face too on the same side e.g. the cheek muscles. The condition may be so diffuse as to affect the muscles on the mouth, neck and forehead- all on the same side
All the muscles on one side of the face are supplied by a nerve called the facial nerve. Hemifacial spasm is thought be due to inappropriate hyperactivity within this nerve causing inappropriate movement of the muscles. In many patients hemifacial spasm develops spontaneously, however in others, hemifacial spasm may occur as result of some problem causing paralysis of the facial nerve itself. In some patients, hemifacial spasm can be caused by irritation of the facial nerve by a blood vessel
Botulinum toxin is a neurotoxin protein which is used in tiny amounts to cause temporary controlled paralysis of muscles. It acts by preventing the nerve from releasing its trigger messenger chemicals (neurotransmitter) which tells the muscle to move. There are varous brands of botulinum toxin which have been licensed for the treatment of blepharospasm/ hemifacial spasm including Botox, Dysport and Xeomin. Regardless of brand of Botulinum Toxin, all treatments are given by injecting tiny doses of the medicine into affected muscles.
The duration of botulinum toxin injection treatment varies from patient to patient and for most patients lasts about 3-4 months on average. Therefore a regular treatment programme will be required.
Botulinum toxin is very effective in the vast majority of patients with blepharospasm and hemifacial spasm. However in a small proportion of patients, botulinum toxin injections are not effective e.g. due to side effects, allergies. For botulinum toxin injections to work, the patients needs to realise that accurate dosage of the medicine and repeated regular injections are necessary. It therefore takes some time to slowly establish the exact dosage, where to inject and how often to inject before the patient gets any benefit.
It is crucial to obtain the correct dosage and be accurate and consistent in injection pattern. Side effects occur due to unwanted paralysis of neighbouring muscles causing drooping eyelids (ptosis), double vision. In the vast majority of patients this is very temporary and most patients tolerate these unwanted effects very well.
In a tiny minority of patients in whom botulinum toxin injections are not tolerated, surgery may be necessary.
Links: The Dystonia society
Here is a small selection of patient testimonials kindly offered by some of Mr Cheung’s previous and current patients, which give some insight into what to expect. All the patients involved have kindly given their consent to the publication on this website. To protect patient confidentiality, any identifying elements have been removed.
"As a senior nurse, I was very discerning in my choice of surgeon , and undertook significant research before deciding to have surgery. I am delighted that I chose David Cheung. From my very first email enquiry, through to discharge, David's communication was excellent. He gave me full explanations and information. My initial consultation was friendly and thorough and by the end I felt fully informed about what to expect, I had ample opportunity to ask questions and was very involved in agreeing with David the outcome we were planning to achieve. The actual surgical experience was positive and I only experienced minimal discomfort. I am delighted with the result of the surgery which has achieved the outcome David and I agreed resulting in a more youthful but natural look."
Dame Catherine Elcoat DBE
“ Dear David, I just wanted to thank you for your extreme dedication and professionalism in coming in specially to perform expert restorative surgery on this young girl on Tuesday morning. I saw her post-op yesterday and the difference compared to pre-op was remarkable and I’m sure will make a huge difference to her in the future. The mother and the girl herself are immensely grateful for your expertise and recognise the vast improvement they can already see…."
Mr JS Barry, Consultant Ophthalmologist, Dudley Group of Hospitals NHS Trust.
" Dear David, we just wanted to say that we are incredibly happy with the final result following our surgery. It has given us so much confidence and has really made such a difference to our lives. We would have loved to see you again but hope you'll understand that we'd rather just send a selfie. Either way they look amazing and we are just so happy with them. Thank you so much for taking the time with us, making sure we were always in the loop and your intricate surgical skills. Thanks so much…."
Miss CC and SC, Glasgow. Surgery performed: Double eyelid surgery/ Oriental Blepharoplasty with medial epicanthoplasty under local anaesthetic at the BMI Edgbaston Hospital.
“ Dear Mr Cheung, Oh what a surprise! How absolutely amazing-I am sitting on cloud 9-admiring myself! On the way home last Wednesday my great friend informed me that I looked like a panda, but she did at least buy me a big bag of frozen peas on the way! I was a little anxious at the thought of looking in a mirror but anticipation too over from fear! What I saw in the mirror was absolutely incredible. I was looking at a person whom I knew very well, but had not seen for many years. This was an absolutely amazing experience. My friends and I all agree. We are absolutely thrilled with the results of my meeting with you and your surgery. We can hardly believe what we are seeing! And now I don’t know how to thank you- for words aren’t adequate. But I will say, “Thank you, thank you, thank you!”-again and again for I am over the moon! I am thrilled beyond words and am looking forward to seeing you again to say “Thank You!’”
Dr JB (retired consultant anaesthetist, Worcestershire). Surgery performed: Combined bilateral upper eyelid ptosis correction with blepharoplasty under local anaesthetic at the West Midlands Hospital, Halesowen
”Dear Sir, thank you very much indeed for the surgery you performed on me, although it was it was recommend to improve comfort it has, how can I put it, benefitted my vision…I believe that the the eyelashes were scratching the lens so following the surgery when this scratching ceased the lens allowed what sight I still have to work better. Before the operation to my right lower lid, I was down to just the left eye for clarity and that is without significant peripheral vision; the right eye was just shapes and colour- in many circumstances the right eye was detracting from the vision in the left eye and often I found it better to cover my right eye. Since the operation I can see again in my right eye. At 60 years old, my GP had told me that I would eventually go blind. Last week though my wife and I went to the photography show at the NEC and I bought a new digital camera. With the wonders of this new technology I can see the results on my new television. For the first time in a long time, I felt confident enough in the future and with my vision to buy this new camera. For the first time in a long time I have felt optimistic enough to buy something like this. Thank you so much. At the age of 87, I am living for the now and the near future, not morosely managing decline. The world is full of people who complain but few notice the good things such as your exceptional service provided…”
Mr GR. Surgery performed: Right lower lid entropion correction at the Russells Hall Hospital, Dudley
" ..Dear Paula Clark, in today’s society people are very quick at making complaints but don’t voice gratitude and acknowledge outstanding professional care. Hence the following letter: I had the privilege of being referred to Mr Cheung a few years ago following the removal of an acoustic neuroma in 1999. I have had continued problems with my left eye since that date. Although it has not probable that I have been his greatest challenge, for me it is a significant irritation when dealing with all of my other medical conditions. I feel it important to mention from the beginning I had an emergency operation in Manchester, which left me with great anxieties re: any further treatment with my eyes. I cannot state this strongly enough. My first meeting with Mr Cheung was amazing. For the very first time in many years, I met a friendly professional who LISTENED. He took my history and talked to me about my concerns and issues that arose. He remained very professional throughout examinations and explained at a level of communication that suited me, exactly what he was doing and talked to me throughout. I don’t feel he understands exactly how good he is with using his holistic skills in communication. He is open and easy to communicate with, which immediately builds a trust between patient and professional. This in turn allows a patient to build confidence and trust. He is open and transparent in his working methods, which again builds trust. I have never felt excluded from my treatment, which I have felt so many times before, which promotes a sense of mistrust. He is a shining example to so many other staff in how to relate to patients and equally I’ve seen him communicate with other professionals and teach students in such a professional and dignified manner. (I hope the students realise how privileged they are.) He is very calming and will explain at a level suitable to the recipient about what is going to happen. Mr Cheung will give useful handouts thus allowing you to take the resources home to enforce all the verbal information given in appointments. His skills in theatre again are professional, calming and promotional to a patient’s holistic needs being met. As previously stated my mistrust with any procedures was a hurdle for me to overcome beyond belief. My first meeting with Mr Cheung restored my trust and allowed me to receive treatment with confidence in his capable professional care. Obviously patients talk in waiting rooms and I can honestly say I have never heard anything but positive feedback. He treats everyone with respect, his friendly persona and open, transparent method of working builds trust.... Please pass on my thanks to Mr Cheung. I hope he is as valued by the health authority as he is valued by the patients he treats….."
Miss SD. Letter to Chief Executive of Dudley Group of Hospitals NHS Trust
Private Patient Appointments
Frequently Asked Questions