Myokymia (Eyelid Twitching)

Introduction

As eyecare practitioners, we frequently hear from patients that they are bothered by twitching in the eyelid of one eye. The eyelid muscles around one eye (only rarely in both) will begin to quiver involuntarily; episodes can be as frequent as several times a day or perhaps once a week.

To the person experiencing it, the entire lid feels like it might be moving, but in reality it is a very small movement, almost unnoticeable by others. While it can be annoying, the twitching is not serious, and is not a medical concern. Almost all cases resolve without treatment within three weeks, and most disappear sooner than that.

Called myokymia (my-oh-kime-ee-ya), this annoying phenomenon is usually due to stress, lack of sleep, fatigue or anxiety; it is also sometimes seen when people are using too much caffeine (sodas, coffee and energy drinks are common sources) or indulging in smoking or overuse of alcohol. Irritation from toxic fumes or a small foreign body in the eye can also trigger myokymia.

Causes

Myokymia is caused by a misfiring of the nerves supplying the muscles of the eyelid. It can be from a single muscle or a group of muscles around the eye, most commonly those that close the lids, the orbicularis. The superior oblique muscle is also sometimes involved, which controls the movement of the eye down and inward toward the nose. When the oblique muscle is involved, the patient may experience double vision during an attack, but this is rare.

In rare situations, this condition can occur as a precursor to blepharospasm, a different type of myokymia which is more severe.

Treatment

Usually, treatment is not necessary, because myokymia almost always resolves by itself within a short time. Depending on how bothersome these small muscle spasms become, the first and easiest method to decrease their frequency is to simply get adequate rest and reduce caffeine intake.

A second remedy is to use either topical or oral antihistamines (allergy therapies), but care should be taken, because oral antihistamines can cause drowsiness. Also, the use of cold packs over the affected eye has been reported to be effective in some cases.

Botox injections have been demonstrated to stop persistent myokymia. However, this could be considered as being in the same category that using a bomb to kill a fly would be in; usually these tiny muscle spasms are not at all that serious. If considered, Botox injection should only be done by an experienced practitioner to avoid damaging the nerves that control other facial muscles.

If myokymia is persistent and severe despite self-treatments such as cutting caffeine, getting more sleep and taking steps to reduce stress, a consultation with an eyecare practitioner is indicated. This is especially important if the frequency of episodes is increasing and/or how long they last, because myokymia can progress into blepharospasm in rare cases.