Eye Twitch and Multiple Sclerosis

What Is Eye Twitching?

Myokymia is involuntary wave-like spasms occurring in the muscles that perform voluntary functions in the body. Myokymias affects the muscles of the face, especially the orbicularis oculi muscle of the eyelid. When there is the involvement of the eyelids, it is known as eyelid myokymia.

What Is Eyelid Myokymia?

Eyelid myokymia is transient, self-limiting, and rippling contractions of the orbicularis muscles responsible for eyelids' closure. Eyelid myokymia is a benign condition that very seldom extends for a longer period. It mostly affects the lower eyelid and has a unilateral presentation.

What Is the Normal Anatomy of the Eyelids?

The eyelids comprise three thin plates of tissue or lamellae, namely the anterior, middle, and posterior lamella. The anterior lamella consists of the orbicularis oculi muscle and skin, and the middle lamellae have orbital fat, subcutaneous tissue, and orbital septum. The posterior lamella consists of the tarsal, conjunctiva, and ocular lens. The facial nerve supplies the muscles of the eyelids.

What Causes Eye Twitching?

Eye twitching is caused due to systemic diseases, including multiple sclerosis (MS), autoimmune disorders, and brainstem pathologies. Other non-disease causes of eye twitching include:

• Caffeine.

• Fatigue.

• Stress.

• Anxiety.

• Exercise.

What Is Multiple Sclerosis and What Is the Main Cause of It?

Multiple sclerosis is an immune-mediated chronic inflammatory condition of the central nervous system. It is characterized by damage to the insulating sheath covering the nerves (myelin sheath). It is more common in females than males and affects people belonging to the twenty to fifty age strata.

The exact cause of multiple sclerosis remains unclear. The most accepted causes responsible for causing MS are genetic factors and environmental factors. Genetic factors, along with environmental triggers like viral infections (Ebstein-Barr virus and human herpesvirus) trigger the progression of the condition.

What Is the Mechanism Behind the Initiation of MS?

MS is an autoimmune disorder where one’s own immune cells start inflammatory reactions against the nerve fibers and myelin sheath of the central nervous system. Destruction of the myelin sheath leads to compromise in the electrical impulse conduction.

How Does MS Affect the Visual Function?

MS is often associated with several visual impairments, including optic neuritis and other ocular motor movements.

• The damage to the central nervous system affects the afferent and efferent pathways of the eye. The afferent pathway destruction mostly results in loss of sensory function of the eye. The optic nerve is most frequently involved, thus leading to visual defects.

• When the different pathway gets affected, there is disruption of the motor supply to the muscles of the pupil and eyes. This ultimately results in faulty ocular movements. Over forty percent of the cases of MS have impaired ocular motor function.

What Are the Ocular Manifestations of MS?

The most common ocular manifestations of MS include:

• Optic neuritis.

• Vision impairment.

• Orbital pain.

• Diminished color vision and contrast sensitivity.

• Inflammation of the papillae.

• Eye twitching.

• Bilateral paralysis of the eye muscles (internuclear ophthalmoplegia).

• Loss of depth perception.

• Nystagmus.

What Are the Other Clinical Features of MS?

Other features of MS, apart from the ocular manifestations, include:

• Tingling sensation.

• Difficulty in speech and swallowing.

• Cognitive impairment.

• Muscle weakness.

• Headache.

• Loss of bladder and bowel function.

• Diminished sexual drive.

What Are the Specific Features of Eye Twitching Linked to MS?

Though eye twitching overall is a self-limiting and transient phenomenon. Eye twitch in MS shows the following features:

• Long-lasting eye twitching.

• Facial spasms.

• Full closure of the eye after twitch.

• The twitch never gets better, even after the removal of the triggers.

When Should We Consult a Specialist for Eye Twitching?

Eye twitching is a common presentation of MS patients, but a specialist consultation might be required in the following cases -

• Continuous eye twitching.

• Incomplete closure of eyelids.

• Difficulty in eye-opening.

• Redness of the eyelids.

• Swelling of the eyelids.

How Is MS Diagnosed?

The following methods diagnose MS and the related ocular manifestations:

1. History and clinical examinations of the MS and eye twitching are performed.

2. Imaging plays a vital role in detecting actual nerve damage.

• Optical coherence tomography (OCT) is performed to diagnose and monitor the progress of the lesions of optic neuritis.

• Contrast-enhanced magnetic resonance imaging (MRI) helps in delineating the plaques present in the nerve fibers and optical neuritis of MS patients.

• Spectral-domain optical coherence imaging (SD-OCT) helps diagnose retinal changes in MS patients.

3. Laboratory tests are advised in atypical presentations of optic neuritis to diagnose any other inapparent or chronic inflammatory condition. The lab tests performed include:

• Antinuclear antibody tests.

• Tuberculin test.

• Erythrocyte sedimentation rate (ESR).

• Lyme titers.

How Is MS Managed?

MS has no particular treatment. Most of the treatment is aimed at relieving the symptoms.

• High-dose intravenous injection of Methylprednisolone and immunoglobulin G (IgG) helps improve the visual acuity, contrast sensitivity, and color vision related to optic neuritis.

• Immunomodulator drugs are used as first-line drugs to manage MS.

• Plasmapheresis is prescribed in patients unresponsive to corticosteroids.

How Is Eye Twitching in MS Controlled?

There is no specific treatment for treating eye twitching in MS patients. However, the following measures help in minimizing the severity of eye twitching.

• Avoid consumption of caffeine, alcohol, smoking, etc.

• Botulinum toxin injection has shown a high success rate in the case of persistent muscle twitching.

• Other treatments for chronic eye twitching include tonic water, calcium, and multivitamin tablets.

What Are The Conditions That Also Present With Eye Twitching?

Ocular manifestations of MS, such as eye twitching, can also be seen in other conditions. Hence it is essential to look for other conditions with similar manifestations. Diseases that also present with eye twitching are:

• Hemifacial spasms.

• Meige syndrome.

• Spastic-paretic facial contracture.

What Is the Prognosis of Eye Twitching Related to Multiple Sclerosis?

The prognosis of MS is poor, with a reduction of five to ten years in the life expectancy of patients diagnosed with MS. Ocular manifestations associated with MS overall enjoy a good prognosis, with improvement in the visual acuity in most cases. However, recurrent episodes lead to unfavorable outcomes.

Conclusion

MS is an autoimmune inflammatory condition affecting the nervous system. Ocular symptoms of MS mostly include the impairment of vision and ocular movements. Eye twitching in MS often continues for a longer period of time and radiates to other facial muscles. In most cases, the visual functions and acuity are restored after treatment.