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The facial nerve or seventh cranial nerve
| Photo Credit: By Patrick J. Lynch, medical illustrator – Patrick J. Lynch, medical illustrator, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=1496677
There’s a condition I’ve treated for over two decades that doesn’t kill, blind, or even leave a visible scar. Yet, for the way it can shatter a life, it is among the cruellest I have encountered in my career. It’s called hemifacial spasm, or HFS. A few years ago, I nicknamed it “the disease of the winking eye” in an article, and the name stuck because it’s tragically accurate.
It all begins with a flicker, a tiny twitch around the eye that anyone might dismiss as a sign of a long, tiring day. But with hemifacial spasm, the waiting changes nothing. The flutter comes back, more often, until it becomes a full-blown wink. Over months and years, this involuntary contraction travels down the face, pulling the cheek and the corner of the mouth into a constant, uncontrolled grimace.
The real cruelty of HFS lies in how the world misinterprets it. A person at a bank counter, in a classroom, or at a reception desk appears to be winking deliberately, even suggestively. They are doing nothing of the sort. They have as much control over that wink as they do over their own heartbeat.
Some patient stories are impossible to forget. Sandeep, a man in his mid-thirties, came to us with his wife, his hand cupped over the side of his face, a posture I now recognise instantly as someone trying to hide from the world. He told me that while reading a magazine at a bus stop, his eye began its rapid, rhythmic blinking. A woman standing next to him became furious, accusing him of winking at her and threatening to call the police. Before he could even try to explain, two strangers had hit him.
