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Eye Twitching Illusion: Myth or Fact?

by | Feb 1, 2025 | Manuscripts | 0 comments

Abhirami Edayath, M.Optom

Assistant Professor, Karpagam Faculty of Medical Science & Research, Coimbatore, India

 

Myokymia is a medical term used to describe involuntary muscle movements that can be visualised on the skin.(1) Eyelid myokymia is described as continuous fine, involuntary, non-synchronous contractions of the striated muscle fibres of the eyelid. (1,2) It is also known as eye twitching, which occurs due to repetitive involuntary spasm of the orbicularis oculi muscles surrounding the eye. (2,3) It is usually considered as unilateral and intermittent. Myokymia can occur in either the lower or upper eyelid, or both at the same time. However, myokymia most commonly occurs in one eyelid at a time.(3) Occurrence of myokymia is transient and lasts from several days to a few weeks or months. The episodes of myokymia can repeat sporadically throughout the day. The frequency and duration of twitching may vary according to individuals. (4,5)

Stress, fatigue, caffeine consumption, lack of sleep and usage of medications like topiramate, clozapine can influence the frequency and intensity of myokymia (6,7) Stress and anxiety can trigger the onset of twitching by affecting the nervous system, leading to increased muscle tension and spasms. Physical and mental fatigue can also induce myokymia by straining the body’s resources and affecting muscle control. Similarly excessive intake of caffeine can stimulate the nervous system, leading to increased muscle activity and triggering eyelid twitching. Insufficient sleep is also considered as a factor causing myokymia because sleep deprivation can affect the body’s ability to rest and regenerate, including the muscles and nervous system, causing eyelid twitching. Other causes of myokymia include multiple sclerosis and autoimmune diseases. (7) Myokymia does not directly affect vision, but constant twitching can temporarily affect daily activities and visual tasks.

Clinical investigations of eyelid myokymia include, history taking regarding the presenting symptoms, precipitating factors, medical history, and lifestyle factors. Since the orbicularis oculi muscle is affected, physical examination of the orbicularis oculi muscle should be carried out. Neuroimaging modalities like a Magnetic resonance imaging (MRI) or Computed tomographic scans (CT), can be done to rule out multiple sclerosis or brainstem tumour. (7)

Management of eyelid myokymia can be done by understanding its causes and lifestyle modifications. To reduce the frequency and severity of myokymia episodes, factors such as stress, fatigue, caffeine intake, and sleep quality should be addressed. Applying warm compresses to the affected eyelid can temporarily provide relief from the twitching. Healthy and balanced diet is also an essential factor for overall eye health and preventing myokymia. Most of the cases treatment is not necessary as eyelid myokymia tends to resolve on its own. Myokymia persisting for more than three months, botulinum toxin injections should be considered as a treatment option to relax the muscle. Other treatment options include calcium, folic acid, phosphorus, potassium, and multivitamins.(8) Rarely orbicularis myectomy can be suggested. Complications of eyelid myokymia include hemifacial spasm, blepharospasm etc. (8,9) Prognosis of myokymia shows spontaneous improvement of symptoms within a few months for most of the cases.

 

References

  1. Vuppala AD, Griepentrog GJ, Walsh RD. Swallow-Induced Eyelid Myokymia: A Novel Synkinesis Syndrome. Neuroophthalmological. 2020 Apr;44(2):108-110
  2. Wessel M, Zimerman M, Timmermann JE, Hummel FC. Eyelid myokymia in an older subject after repetitive sessions of anodal transcranial direct current stimulation. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation. 2013 May 1;6(3):463-5.
  3. Khalkhali M. Topiramate-Induced Persistent Eyelid Myokymia. Case Rep Psychiatry. 2016;2016:7901085.
  4. Medrano-Martínez V, Pérez-Sempere A, Moltó-Jordá JM, Fernández-Izquierdo S, Francés-Pont I, Mallada-Frechin J, Piqueras-Rodríguez L. Eyelid myokymia in patients with migraine taking topiramate. Acta Neurol Scand. 2015 Aug;132(2):143-6.
  5. Horowitz SH. Hemifacial spasm and facial myokymia: Electrophysiological findings. Muscle Nerve 1987;10:422-427.
  6. Moshirfar M, Somani SN, Shmunes KM, Ronquillo YC. Will Tonic Water Stop My Eyelid Twitching? Clin Ophthalmol. 2020;14:689-691
  7. Jordan DR, Anderson RL, Thiese SM. Intractable orbicularis myokymia: Treatment alternatives. Ophthalmic Surg 1989;20:4:280-3
  8. Banik R, Miller NR. Chronic myokymia limited to the eyelid is a benign condition. J Neuroophthalmol. 2004 Dec;24(4):290-2.
  9. Palasí A, Martínez-Sánchez N, Bau L, Campdelacreu J. Unilateral eyelid myokymia as a form of presentation of multiple sclerosis. Neurologia. 2013 Apr;28(3):187-9.

 

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