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More Than the Blink of an Eye: Myokymia and Blepharospasm

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Has your eyelid ever started involuntarily twitching? It happens to most of us from time to time and usually passes quickly. But persistent twitching around the eyelids can quickly become bothersome or even dangerous. When it occurs, it’s typically due to one of three conditions: benign myokymia, blepharospasm, or hemifacial spasm.

Benign eyelid myokymia most commonly affects the lower lid on one side of the face. Myokymia can last for hours, days, or even weeks. Though it’s rare, some cases can even last years. Importantly, myokymia does not involve twitching on another area of the face — if you’re experiencing twitching elsewhere, schedule a visit with your internist or neurologist.

Myokymia can result from fatigue, lack of sleep, overexertion, smoking, alcohol, caffeine, or stress. In many cases, cutting down on the likely stressors will help improve symptoms. If your case lasts for several weeks and proves bothersome, isolated Botox injections are an option. When the injection wears off in three months, the condition is usually resolved.

Blepharospasm is a rarer but more severe cause of eye twitching. It results from a brain misfire that sends too many signals to the nerves around the eyes. These aberrant signals cause twitching that is often both frequent and intense — a bit like the sensation you get when your anti-lock brakes kick in. Sometimes, patients cannot keep their eyes open, making it unsafe to drive or engage in other activities.

Though blepharospasm has no cure, treatment is available. Injecting Botox into the lateral crows’ feet region and the inner eyelid corners every 3–4 months can help the muscles relax without causing droopiness. Preventing dry eyes and reducing the same stressors that cause myokymia can also help with these symptoms.

If involuntary twitching occurs throughout one side of the face (not just the eye), it’s likely due to a nervous system disorder called hemifacial spasm. It typically happens because an artery in the brain pulsates against a cranial nerve called the facial nerve. As with other conditions, Botox can help and, in more serious cases, surgery can relieve the spasms.

If your eyelid twitching doesn’t resolve itself within a few weeks, visit your doctor to determine what treatment options are available. If necessary, Eye Plastic Associates can administer Botox to reduce twitching and restore your function. Hopefully, you will never need our help with these conditions, but we will be here if your eyelid twitching goes from irritation to being something more serious!