Orbicularis Oculi Trigger Points

Introduction

The orbicularis oculi is a key facial muscle responsible for closing the eyelids, blinking, and protecting the eyes. When trigger points develop in this muscle, they can cause eye strain, headaches, and facial tension, often mimicking migraines, sinus pain, or trigeminal nerve dysfunction.

Name and Area

  • Name: Orbicularis Oculi

  • Area: Surrounds the eye socket, running from the medial orbital rim to the skin around the eyelids.

Indications

Orbicularis oculi trigger points may contribute to:

  • Pain or Tightness Around the Eyes (Mistaken for Sinus Pressure or Eye Strain)

  • Headaches That Originate from the Eye Area and Spread to the Temples (Can Mimic Tension Headaches or Migraines)

  • Twitching or Spasms in the Eyelids (Common in Stress, Fatigue, or Overuse of Digital Screens)

  • Pain That Extends to the Bridge of the Nose or Forehead (Can Resemble Sinus Headaches or Eye Fatigue)

  • Sensitivity to Light or Screens (Common in People Who Work at Computers for Long Hours)

  • Pain or Tightness That Worsens with Stress, Squinting, or Poor Lighting

Pain from this muscle is often mistaken for tension headaches, eye strain, or sinus pressure.

Muscle Action

  • Closes the Eyelids: Essential for blinking, winking, and protecting the eyes.

  • Assists in Tear Drainage: Works with lacrimal function to keep the eyes lubricated.

  • Supports Facial Expressions: Involved in smiling, squinting, and expressions of concern.

The orbicularis oculi is essential for eye protection, facial expressions, and vision comfort.

Signs and Symptoms

Individuals with orbicularis oculi trigger points often report:

  • Pain or Tension Around the Eyes That Feels Like a Deep Ache or Tightness

  • Frequent Eye Strain or Fatigue, Especially After Long Screen Time

  • Twitching or Spasms in the Eyelids (Can Be Persistent or Intermittent)

  • Pain That Extends to the Temples or Nose (Can Resemble Sinus Headaches or Migraines)

  • Increased Sensitivity to Bright Light or Glare

  • Tightness in the Eyelids That Makes Blinking Feel Strained

Pain worsens with prolonged screen use, squinting, bright light exposure, or emotional stress.

Perpetuating Factors

Common causes of orbicularis oculi trigger points include:

  • Excessive Screen Time (Prolonged Computer Use, Phone Use, or Gaming Without Breaks)

  • Frequent Squinting Due to Poor Vision (Common in Those Who Need Glasses or Have Incorrect Prescriptions)

  • Chronic Stress or Anxiety (Leads to Increased Facial and Eyelid Tension)

  • Frequent Exposure to Bright Light or Poor Lighting Conditions

  • Eye Fatigue from Reading or Driving for Long Periods

Trigger Point Referral Pattern

Trigger points in the orbicularis oculi refer pain to:

  • The area around the eyes (Can Mimic Eye Strain or Dry Eye Syndrome)

  • The temples and forehead (Mistaken for Tension Headaches or Sinus Pain)

  • The bridge of the nose and upper cheeks (Can Resemble Sinus Congestion or Facial Pressure)

Pain from this muscle is often confused with sinus headaches, migraines, or eye strain from digital devices.

Differential Diagnosis

Orbicularis oculi trigger points may be mistaken for:

  • Tension Headaches (Pain That Spreads from the Eyes to the Temples, Common in Stress and Postural Imbalances)

  • Migraines (Severe, Pulsating Headaches That May Include Light Sensitivity and Nausea)

  • Sinus Headaches (Pain and Pressure in the Forehead and Around the Eyes, Often Accompanied by Congestion)

  • Trigeminal Neuralgia (Sharp, Shooting Facial Pain That Can Resemble Nerve Compression)

  • Blepharospasm (Involuntary Eye Twitching That Can Occur with Stress or Fatigue)

A thorough eye, facial, and neurological examination is necessary to rule out these conditions.

Associated Trigger Points

Orbicularis oculi trigger points often co-exist with:

  • Frontalis (Forehead Pain and Tension, Common in Stress and Postural Imbalances)

  • Temporalis (Side Headaches and Jaw Pain, Can Resemble Migraines or Sinus Pressure)

  • Sternocleidomastoid (SCM) (Neck and Head Pain, Can Mimic Sinus Pressure or Tension Headaches)

  • Upper Trapezius (Shoulder and Neck Tension, Common in Postural Strain and Stress-Related Pain)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Orbicularis Oculi Medial orbital rim, frontal bone, maxilla Skin around the eyelids Facial nerve (CN VII)

The orbicularis oculi is innervated by the facial nerve (cranial nerve VII), which also controls blinking, eye protection, and facial expressions.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the eyelids, brow, and upper cheekbones.

  • Blinking Function Testing: Assess pain or tightness when forcefully closing and opening the eyes.

  • Light Sensitivity and Screen Exposure Testing: Determine if prolonged screen time worsens symptoms.

  • Postural and Facial Expression Assessment: Rule out habitual squinting or eye strain from poor lighting.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the orbicularis oculi, reducing muscle tightness and improving eye comfort.

Manual Therapy

  • Trigger Point Release: Apply gentle sustained pressure along the eyelids and brow.

  • Facial and Scalp Massage: Helps improve circulation and reduce muscle tension around the eyes.

Stretching

  • Eye Relaxation Techniques: Close the eyes gently and press the palms against them to relieve tension.

  • Eyebrow and Forehead Massage: Helps reduce excessive eye strain and forehead tightness.

Strengthening Exercises

  • Blinking Drills: Helps improve eye lubrication and reduce excessive squinting.

  • Focus and Relaxation Exercises: Alternate focusing on near and far objects to reduce eye fatigue.

Postural and Behavioral Adjustments

  • Follow the 20-20-20 Rule (Every 20 Minutes, look 20 Feet Away for 20 Seconds to Reduce Eye Strain)

  • Use Proper Lighting (Avoid Working in Dim or Overly Bright Environments That Force Squinting)

  • Wear Proper Prescription Glasses (Reduces Unnecessary Eye Strain and Prevents Squinting)

Conclusion

The orbicularis oculi plays a crucial role in eye protection, facial expressions, and blinking, but trigger points in this muscle can cause significant headaches, eye strain, and facial tension. By incorporating dry needling, manual therapy, stretching, and vision care adjustments, individuals can reduce pain, improve eye comfort, and prevent tension-related headaches.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.