Eyelids play an important role in eye health, helping to keep the eyes lubricated and protect many areas of the eye (cornea, iris, lens, sclera, and more) from foreign bodies. In most people, the eyelids seamlessly open and close without issue. However, others can experience eyelid twitching or spasms that range from mild to severe. In this blog, we will explain why this happens and when you should see an ophthalmologist.
Causes of Eyelid Twitching
The human body has many muscles and nerves in the face to help carry out basic functions. Specifically in the eye, the orbicularis oculi muscle closes the eyelids via stimulation from the seventh cranial nerve. Eye twitching can occur whenever either of these structures are impacted.
Here are the three most common causes of eyelid spasms:
Eyelid Myokymia
Myokymia is an umbrella term to describe involuntary muscular movement that resembles fluttering or quivering of the muscle. In the case of eyelid myokymia, involuntary muscle movements occur in the orbicularis oculi, causing the eyelid to spontaneously flutter or contract and create the appearance of a twitch.
Eyelid myokymia is a benign or harmless phenomenon and does not threaten your vision. It is more of an annoyance than anything. It typically involves one eyelid but it can vary in its location or frequency; it is usually brief and intermittent. Being overly-tired, stress, and caffeine consumption are common triggers of eyelid myokymia.
Benign Essential Blepharospasm
Essential blepharospasm (or simply “blepharospasm”) is a neurological disorder that causes the eyelids of both eyes to close involuntarily. This condition is a type of dystonia, meaning that the involved muscles remain contracted for longer periods of time, in contrast to myokymia where the movements are very brief. Initial symptoms include frequent blinking followed by eyelid closure, and these movements are uncomfortable, undesired, and involuntary.
Eyelid closures can last seconds or hours, with more advanced episodes resulting in closure that impacts your vision. While uncommon, this type of eyelid problem can make it difficult to carry out routine tasks such as driving a car, reading a book, walking down the street, or working. It is also usually associated with sensitivity to light and a feeling of eye discomfort and can also be associated with anxiety. Blepharospasm can be distinguished from eyelid myokymia because it affects both sides, whereas eyelid myokymia usually only affects one eyelid.
Hemifacial Spasm
Hemifacial spasm is a type of neuromuscular disorder that causes facial muscles on one side of the face to move involuntarily. In most cases, blood vessels press against facial nerves and this causes the muscles to uncontrollably move or spasm. In rare cases, hemifacial spasm can be due to prior facial nerve trauma or even compression due to a brain tumor. Hemifacial spasm can be distinguished from eyelid myokymia and blepharospasm because it only involves one side of the face, and involves the entire side of the face (rather than the eyelid exclusively).
How to Spot Eyelid Twitching
The frequency and severity of eyelid twitching varies in each individual. Some people may experience them every few seconds, while other episodes are less frequent but last longer (for days or weeks).
Eyelid twitching mostly affects the upper eyelid, although ocular myokymia can impact the lower eyelid. You may also experience twitching in one eye (unilateral) or both eyes (bilateral). Additionally, the lid can either close partly or entirely.
While spasms are a key indicator of eyelid twitching, eye irritation, dry eyes, and an increase in blinking can all be telltale signs and symptoms. You may also notice an increased sensitivity to light and vision problems.
When to See a Doctor
Although most cases of eye twitching are not serious, you should still be mindful of potential symptoms that may indicate a more complex eye condition that requires a visit to an ophthalmologist.
Call your eye doctor if the twitching persists for several weeks or if you have difficulty opening your eye or moving your face normally. Issues with your eyelid can produce double vision and weakness that produces a numb or tingling feeling. In other cases, your eyelid may begin to droop or your eye may become swollen or produce discharge. These are also signs of a more severe condition.
How to Treat Eyelid Twitching
For cases of eyelid myokymia, simple changes to your diet, mental health, and sleep hygiene can help reduce episodes of eyelid twitching. For example, reduce the amount of caffeine you consume, as caffeine acts as a stimulant. In addition, limit your stress and be sure to get a good night’s sleep every day. There are also instances in which dry eye can lead to eyelid spams. Keeping your eyes lubricated with artificial tears can help prevent twitching.
Treating eyelid twitching caused by blepharospasm or hemifacial spasm is more involved. Your options include medications, injections, and, in rare cases, surgery.
Injections: Botulinum toxin injections (for example, Botox or Xeomin) are usually the first treatment option for blepharospasm and hemifacial spasm. The medicine, which is injected above and below the eye, works by blocking chemical signals from nerves to temporarily relax muscles. The injections can last up to three months.
Medications: For people who cannot receive injections or whose injections do not work, certain oral muscle relaxers (baclofen), antispasmodic drugs (trihexyphenidyl), antipsychotic drugs (haloperidol), and anticonvulsant medications (carbamazepine or clonazepam) may provide relief. Haloperidol and clonazepam can treat blepharospasm; carbamazepine and baclofen can treat hemifacial spasm.
Surgery: To treat essential blepharospasm, a procedure called a protractor myectomy partially or entirely removes the eyelid muscles themselves. Previously, a neurectomy was also used to remove parts of the facial nerve responsible for causing the spasms, although this procedure is less common because the nerves can regenerate. To treat hemifacial spasm, a procedure called a microvascular decompression removes the blood vessel from the nerve to relieve the pressure that causes the spasms.
