eyelid twitching

What is eyelid myokymia?
The short answer: it is a sudden spasm, or twitch, of the eyelid muscle.  The long answer: it is an involuntary misfiring of the neurons that innervate the orbicularis oculi muscle (the muscle that closes the eye). (1)

Eyelid myokymia typically involves one eye (unilateral), affects the lower lid more often than the upper lid, and goes away on its own (self-limiting).  It usually comes and goes, but some cases can last for weeks or even months.  This condition is typically harmless (benign), though it can be a sign of a neurological problem if it spreads to other facial muscles.


What is eyelid myokymia NOT? 
There are a couple of eyelid conditions that may sound like eyelid myokymia, but are not the same.

• Essential Blepharospasm: This is an involuntary, episodic contraction of the eyelid muscles that affects both eyes. It can take the form of increased blinking or forceful eyelid closure.  
• Hemifacial Spasm: This is an involuntary condition that involves the eyelid muscles as well as the muscles of the cheek, mouth and neck of only one side of the face. Unlike the other conditions, this finding may be suggestive of a brainstem issue, so an MRI is indicated.

What is it caused by?

• stress
• lack of sleep
• excessive caffeine or alcohol consumption
• eye irritation (due to a foreign body, dry eye, allergies, etc)
• eyestrain (due to vision-related stress)

How is it treated?

• Reduce triggers (ie: get some sleep, go easy on the caffeine, reduce your stress).  I know, it's easier said than done!  
• See your optometrist to treat any underlying disorder that may be present (ie: remove the foreign body, begin dry eye therapy, correct your prescription, etc).
• Topical and/or oral antihistamines have been used off-label to treat this condition, as some evidence indicates that histamine can cause eyelid twitching.(2) 
• Drink tonic water.  Tonic water has low levels of quinine, which relaxes the spasming muscle.(3)
• Botox injections may be used for severe, persistent cases.

(2)(3) Bartlett, Jimmy D and Siret D. Jaanus. "Diseases of the Eyelid." Clinical Ocular Pharmacology, Fifth Edition (2008), pg 407-408.

CliffsNotes:  Eyelid myokymia is a twitching of the muscle that closes the eyelid.  The best way to get rid of it is to drink less soda/coffee, catch some ZZZZs, and chill out.  If the twitching continues for a long time, or spreads to other facial muscles, be sure to see your eye doctor.

Additional Recommended Resources:

• All About Vision: Eye Twitching
• Eyelid Spasms