Eyelids and tiredness

The way the eye and its related features work is, at the same time, very quick and automated. It is the same for the blinking of the eyelids which is the shortest reflex of the organism.
It is striking, though, that the pathologies of sleep are almost never mentioned in front of a chart of neurodystonia affecting the eyelids.

Blepharospasm or eyelid spasm, («tonic, clonic or tonic-clonic contractions of the orbicular muscle of the eyelids» Méd. Biol. t.1 1970) is the often very annoying sensation of small shakes of an inferior eyelid, occuring in more or less repeated seizures (not always noticed by relatives). That symptom is most often neglected as long as it doesn’t hamper daily life. In our experience, the first cause of benign blepharospasm is the lack of sleep. That phenomenon belongs to the set of functional disorders synonymous with hypo-sleep. Like many similar disorders, it was thought for a long time that it was caused by an hypothetic lack of magnesium, analogous with «spasmophilia (or tetany)».

Until 1992, the liability of a lack of magnesium was accepted by everyone and we can still read, on some magnesium based medication boxes : «Lack of magnesium causes irritability, stress, ants sensations, stirring of the eyelids, nervousness»
Yet, since 1989, it is acknowledged that it is not legitimate to carry out a magnesium assay (cf. spasmophilia)

Example

Miss F. is a teenager who consults for troubles with school. During the interview, she yawns several times and we hear that she has a lot of difficulty falling asleep in the evenings (while she has to get up at 7 a.m.) In the week-ends, she goes to sleep even later since she has the legal age to go to discotheques and sleeps most of Sunday. On the functional level, F. complains of irregular and painful menstruation, of orthostatic hypotension causing dizzy spells, and of spasms of an inferior eyelid (her mother thought she lacked magnesium).

Discussion

The application of sleep hygiene measures (cf. the nap), designed to better manage the deficiency, will save that young girl a lot of trouble whereas magnesium supplements will be of no help once she will have to face other difficulties of life.

When they are looked for during the interview (providing the carer who carries out the interview thinks about them), stirrings of the eyelid are almost always retrieved in subjects who lack sleep. That sign stands as an alarm sign and often predicts a more "noisy" symptom (migraines-, stiff neck or spasmophilia (or tetany) attacks).

In practice, it is rare that the sick person makes the link between those disorders and tiredness.

Just like migraine, blepharospasm may become a true handicap and sick people are guided towards specialized treatments with injections which paralize that muscle or with «small» (and irreversible) surgical operations.
Apart from the specific lesional causes, people expose themselves to frequent iatrogenic complications [1] and a prior somnological survey should be considered indispensable.

The narrow link which binds the oculomotor muscles and the automatic nervous system explains though easily why «stress» and annoyances are amongst the accepted causes of some true blepharospasms in the absence of any by the neurologist or ophtalmologist detectable pathology.

NB: «Handicaping blepharospasm» belongs to the broad neurological chart of «dystonias». For complete information, please refer to the site of the People who suffer from dystonia or of the Association of people who suffer from blepharospasm (at the bottom of the page).

Pieter Bruegel l’Ancien (1525-1569), (détail d’un vieillard)

Some blepharospasms of lesional origin (which are not related to sleep) can be combined with a clenching of the jaw or mouth opening, grimaces or lingual spasms, thereby making up the Meige’s syndrome or Brueghel syndrome (referring to the Flemish painter because one of his paintings evokes that grimace).

Caution: the existence of these sometimes dramatic charts may not hide the fact that eyelid spasms and stiff neck are, in most subjects, often harmless and reversible. But they have, like all functional disorders, the characteristic of arousing major anxiety and to be difficult to treat. (The four cardinal points of the functional disorders: disabling, worrying, capricious and, yet, benign).

In practice, except for the rare atypical or lesional forms, and whatever be the associated treatment, rest is the best medication.
As such, it would probably be fruitful to carry out studies about the role of sleep in these "neuro-dystonic" sick people because the complaint of tiredness is systematically a part of the chart, and, on the other hand, these symptoms are frequent in fibromyalgia.

Learning about the rules of sleep hygiene can be an alternative to the difficult treatments of blepharospasm, all the more since the chances to recover spontaneously are high.

Besides, investigation for that symptom can take part in screening a chronic lack of sleep from which 10 to 30% of French people suffer. Excessive daytime sleepiness, which results from it, often remains unnoticed while, in our opinion, it expresses itself early through numerous functional disorders like blepharospasm.