Symptoms of Hemifacial Spasm

The main symptom of hemifacial spasm is the tic itself, which may manifest itself in a number of ways. Symptoms usually occur on only one side of the face, but in some rare cases there are spasms on both sides. Symptoms may include:

  • A small twitching of one eyelid, which may pull the eye shut and cause the eye to tear up
  • More pronounced spasms along one side of the face, affecting the cheek and mouth
  • Pain behind the ear
  • Hearing changes
  • Larger spasms extending the length of the face from the eye to the chin

Unlike trigeminal neuralgia, hemifacial spasm has symptoms that often continue during sleep.

Although the minor twitch of an eyelid is common and not necessarily a symptom of hemifacial spasm, a stronger spasm that pulls the eye shut and causes the eye to tear up may be a sign of early hemifacial spasm. Since the condition can be most effectively treated when diagnosed early in its progression, patients with pronounced eyelid twitches should be evaluated by an expert in hemifacial spasm.

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Reviewed by: Philip E. Stieg, PhD, MD
Last reviewed/last updated: April 2021

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