Involuntary eyelid twitching also called “myokymia” is a common problem faced by many of my patients. This disorder, though seemingly harmless, can cause quite a bit of inconvenience and does need a proper workup by a qualified eye specialist.
Why Does the Eyelid Twitch?
The basic problem in myokymia lies in the nerves. It is a hyper-action of the nerves supplying the orbicularis oculi (the muscle which helps with the closing of the eye).
What Causes the Nerve to Become Hyperactive?
The problem can be due to three main causes:
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Essential myokymia - due to reduced sleep, excessive coffee/tea, or ocular surface disorders. The twitching intensity is quite mild.
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Blepharospasm - these are episodic attacks of much more intense twitching and the patient cannot open his eyes without help. This condition involves a large portion of muscles of the face and needs a specialist consultation (both eye specialist and neurologist).
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Compression of the facial nerve (Cr. VII) - this can only be diagnosed by an eye surgeon. This may need a CT scan/MRI of the brain.
Can Some Medicines Cause This?
Yes, there are a few drugs which can cause eyelid twitching. The most common one being Clonazepam, which is used for epilepsy. You can always check with the doctor who prescribed the medications about this.
What Can I Do at Home to Stop the Twitching?
The simplest measures are:
- Avoid excessive use of visual display units (computers/mobile phones/tablets/televisions) as these can lead to ocular surface disorders.
- Avoid or limit the intake of tea/coffee. These are stimulants, and as you know, the twitching is due to excessive stimulation of the nerves.
- Get at least eight hours of sleep a night.
- Using lubricating eye drops such as 0.5 % Carboxymethylcellulose eye drops four times a day for up to a month provides soothing relief. Tablet Calcium carbonate with vitamin D3 twice a day for two weeks is also found to be helpful.
What to Expect When I Meet the Eye Doctor?
The doctor will try to evaluate you so as to narrow down the problem from the above list of three most probable causes and rule out the other two.
The eye specialist will take a detailed history. The eye exam may include a slit-lamp examination for detecting ocular surface disorders. The examination also includes an examination of cranial nerve VII.
What Are the Other Treatment Options Available?
- Treatment for specific ocular surface disorders may be eye drops or surgery.
- Treatment for blepharospasm - neurologist may start medicines to blunt the hyper nerve action.
- Treatment in cases unresponsive to medication include injections with botox (botulinum toxin), eyelid surgery, and facial nerve decompression surgery.
In some rare cases, eyelid twitching can be a sign of a chronic movement disorder if accompanied by facial twitches. So, it is better to consult a doctor if you feel that your eyelid twitch is not normal.
