A woman lowers her sunglasses as her eye twitches and her one eyebrow goes up.

Is Your Eyelid Twitching or Are You Flirting With Me?

Have you ever been talking with someone and they ask you, “Did you just see that?”

"See what?" you say. “My eye; it was twitching. There it goes again!”

Only if someone were to point it out and immediately ask me to stare — rather watch their eye very closely and wait for the flirty movement to repeat itself — might I catch the tiniest of winks. Otherwise, I’ve never really noticed eyelid twitching on someone else.

Feeling my own eyelids twitch

But, I have definitely FELT my own eyelid twitch at times and I definitely wasn’t winking at anybody. Sometimes, the twitch is a brief curiosity or minor annoyance. At other times, it becomes highly distracting, seemingly impossible to stop, and strong enough to gently put a moment of pressure on my contact lens.

Eyelid twitching is common

Mild eyelid twitching — called eyelid myokymia — is fairly common, although the exact prevalence is unknown.1 Myokymia refers to involuntary muscle contractions that cause a rippling effect on the skin. Eyelid myokymia is described clinically as a spontaneous, repetitive, involuntary muscle contraction and relaxation of the fine muscle fibers of an eyelid.1 In patient vernacular, eyelid myokymia is described as twitching.

How does myokymia affect the eyes?

More frequently the lower eyelid is affected, but myokymia can affect the top eyelid as well. The twitchiness typically occurs on one eye at a time, rather than both eyes simultaneously. It usually happens in adults but can occur at any age.

Eyelid myokymia is a benign condition that is self-limited, meaning it goes away on its own, in most people. An attack might last seconds to hours, but occasionally the repetitive contractions could continue for days or weeks.2 Sometimes eyelid myokymia might be an early sign of or associated with a different condition.

What triggers the twitching?

The exact cause is not known. But recognized common triggers include stress, fatigue, anxiety, exercise, excessive caffeine or alcohol consumption, and eye strain or irritated eyes (due to dry eyes or other inflammatory conditions). Medications like topiramate, clozapine, gold salts, and flunarizine can trigger eyelid myokymia, although this is not common. Other reported causes include multiple sclerosis, autoimmune diseases, and conditions affecting the brainstem.2

Stress and fatigue

I have noticed that my eyelids tend to twitch if I’m really stressed out, tired, or fatigued. I’m not aware of the twitching occurring anytime I’ve been fully rested, totally relaxed, and blissfully at one with the world. Hard for me to know how much caffeine might contribute to it because I definitely consume lots of coffee to stay awake on most days, but eyelid twitching is more of a rarity for me.

Besides eyelid twitching, I have experienced a subtle twitchiness of a little muscle just above my mouth. I always presumed that this had to do with muscle fatigue caused by playing my horn for long periods of time, but now I know the medical term for it—myokymia.

How can you get rid of the twitching?

You may be able to reduce the occurrence of eyelid twitching by getting more sleep, reducing caffeine and/or alcohol intake, incorporating stress reduction techniques into your lifestyle (e.g., exercise, deep breathing exercises, meditation), and using artificial tear eye drops to reduce dry eyes if they are a known trigger for you. If you are experiencing painful and/or red eyes, please consult with your eye doctor.

For me, it is sometimes helpful to gently hold a finger just on or near the twitching muscle to calm the nerve down. If the twitching becomes chronic and severe, Botox injections may provide relief for 12-18 weeks by reducing the spasms.

Can the twitching signal something else?

There are times that eyelid twitching might show up before another condition develops or is diagnosed. Examples include the following:1

  • Benign essential blepharospasm: a movement disorder (dystonia) characterized by increased blinking and involuntary eyelid closure.3
  • Hemifacial spasm: a one-sided, involuntary facial movement caused by damage to the 7th cranial nerve that controls the muscles of facial expression and the sensation of taste. Bell's palsy is a condition caused by damage to the 7th cranial nerve.
  • Spastic-paretic facial contracture: a one-sided facial hardening or shortening of muscles due to dysfunction arising from the pons area of the brainstem. This can be associated with brainstem tumors, vascular lesions, and multiple sclerosis.1
  • Facial myokymia: characterized by an involuntary quivering of facial muscles, not isolated to the eyelids. (Now I know this is what I’ve experienced near my mouth. I’ve never thought to mention this to my neurologist.)

Is eyelid twitching enough to suspect MS?

Although eyelid twitching is common and can be connected to nerve damage, it is unlikely that a doctor would suspect MS based on eyelid twitching alone. If other neurological symptoms are present, however, testing might reveal central nervous system damage that may be traced back to MS.

Questions for the community:

Have you ever experienced eyelid twitching? if so, how long does it last and what do you do about it? Have you ever discussed it with your neurologist?

Be well my friends,
Lisa

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