Eye twitching

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Medically Verified By: Dr Janak Shah

Eye twitching is abnormal blinking of the eyelid that is a completely involuntary action (automatic action). The other name for eye twitching is eyelid spasm. Eye twitching is a sudden action and may last for minutes, hours, or longer, maybe for days. Two muscles control eye blinking, one muscle controls the eyelid closing, and another muscle controls the eyelid opening. If there is any problem with any of the two muscles, eye twitching occurs. Generally, eye twitching is normal, harmless, and a little annoying when it lasts for a short duration. However, in some people, eye twitching may signal neurological problems, including hemifacial spasm and blepharospasm. In these conditions, the eyelid closes for a long time, limiting or completely blocking the vision. These problems are less common, so you should not worry much when you feel eye twitching. For most of us, eye twitching is for a shorter period and is minor annoying. When eye twitching occurs for a longer period, it becomes very annoying and a matter of concern.

Types

The most common types of eye twitching are hemifacial spasm, eyelid myokymia and essential blepharospasm. Below are the details on these three types of eye twitching:

Hemifacial Spasm: This is a neuromuscular disorder in which involuntary closure of the eye occurs along with muscles in the mouth, cheek and neck. Only one side of the face involves in this condition. Middle-aged or older women are affected most commonly with this condition. It starts as twitching of the eyelid muscles, gradually resulting in complete closure of the eye. The reason for this condition is irritation of the facial nerves.

Eyelid Myokymia: This condition is a mild event of occasional eye twitching. In most persons, treatment is not required.

Benign Essential Blepharospasm: It is a sustained involuntary condition that involves both eyes. In benign essential blepharospasm, the first symptom is increased eye blinking rate. This further leads to the closing of the eyelids and muscles squeezing around the eyes. In some cases, muscles of the neck or mouth are also involved. These spasms can lead to significant functional impairment, and the involuntary eyelid closure can cause an inability to see temporarily. Essential blepharospasm occurs rarely but is very bothersome. Long-term treatment may be required in case of benign essential blepharospasm. In severe cases, people are unable to keep their eyes open which may result in serious vision impairment. The suspected reason for this is the malfunctioning of the basal ganglia of the brain.

Symptoms

The severity and frequency of eye twitching vary from person to person. Some persons feel it for seconds or minutes, and then eye twitching goes away on its own. However, some persons may experience it for longer periods ranging from hours to a few days. The most frequent symptoms of eye twitching are eyelid spasms and twitching, in addition to this, people may also feel:


  • Eye irritation (generally the first symptom)

  • Facial spasms

  • Increased blinking rate

  • Vision problems, in case of frequent twitching

  • Light sensitivity

Causes And Risk Factors

Causes

The most common reason for eye twitching is ocular myokymia. Ocular myokymia does not cause other problems. There are varieties of factors that trigger myokymia occurrence. Lack of proper sleep is one and primary of those factors. The other reasons for ocular myokymia are consuming too much caffeine, stress and tiredness. When both eyes twitch simultaneously, it is often because of blepharospasm. There is not much known about the cause of eye twitching, but scientists believe it is a problem that arises from a part of our brain called the basal ganglia. Below are the other reasons that can cause eye twitching commonly:


  • Overtiredness

  • Stress

  • Overuse of caffeine

  • Dry eyes

  • Contact lenses

  • Exhaustion/lack of sleep

  • Light sensitivity

  • Frequent squinting

  • Smoking

  • Bright lights

  • Air pollution

  • Wind exposure

  • Alcohol consumption


Below are the other reasons that can cause eye twitching but rarely:

  • Parkinson disease

  • Reaction to certain medicines used for some neurological conditions

  • Meige syndrome, a disorder of the nervous system

  • Brain damage from stroke or inflammation.

  • Hemifacial spasm

  • Multiple sclerosis

  • Bell palsy


Risk Factors

Eye twitching sometimes can be an indicator of diseases listed above.

Prevention

Below are the preventive measures for eye twitching:


  • Limit screen time and other activities which cause eye strain.

  • Take measures to remain free from stress.

  • Take breaks frequently during screen time.

  • Get plenty of sleep to keep your eye muscles relax.

  • Limit the intake of caffeine.

  • When you feel your eyes are fatigued, give proper rest to your eyes.

  • Minimize the use of mobiles.

  • Try the 20-20-20 exercise, i.e., while working on screens, take a break after every 20 minutes, then look at the object distant 20 feet from you and look at that object for 20 seconds.

  • Involve in techniques that provide you relaxation, such as meditation or yoga.

Diagnosis

When eye twitching is troublesome, you should consult a doctor to rule out other problems such as [4]:


  • Bell’s palsy

  • Multiple sclerosis

  • Blepharitis (inflamed eyelids)

  • Dystonia

  • Tourette syndrome

Treatment

Below are the treatment options based on the type of eye twitching:


  • Minor eyelid twitches require no treatment as they usually resolve spontaneously. Reducing stress, using warm soaks, correcting any refractive error, and lubricating the eye with artificial tears may help. Some ophthalmologists recommend reducing caffeine usage.

  • Blepharospasm can be treated with oral medications such as tetrabenazine, focal injection of botulinum toxin, or surgery in which eye muscles are removed. Around 1/3 of affected persons are treated with oral medications. However, the results of these treatments are not promising, and the effect lasts for a short time. Additional medications used for the treatment of blepharospasm are clonazepam, trihexyphenidyl, baclofen, and diazepam.
    Botulinum toxin injections are now the frequently recommended treatment for blepharospasm. Botulinum toxin via injection is injected in minute quantities into the muscles around the eyes to stop the spasm. The injection results remain for several months, but it is not a permanent cure. Usually, the injection is required to be repeated three to four times a year. The treatment is successful and has few adverse effects. The rare side effect of this treatment is double vision or drooping of the eyelids. Side effects typically remain for 1 to 2 weeks, while the positive effects last three months. In addition to botulinum toxin treatment, surgery is needed occasionally to remove the involved muscles. Surgery is the option of treatment in persons who do not respond to oral medications or botulinum toxin injections.

  • Botulinum toxin injections are used to relieve the facial and eyelid spasms in patients experiencing a hemifacial spasms. A neurosurgical procedure called microvascular decompression can also reduce the facial spasms in a person having a hemifacial spasm. It is major neurosurgical surgery and may have serious complications; however, it is successful most of the time.

Complications

There are rare chances of eyelid twitching complications as it is a temporary, preventable issue, and easily treatable. In rare cases, people feel the further complications from eye twitching listed below:[6]


  • Drooping eyelids

  • Blurred vision

  • Excessive tearing

  • Double vision

  • Permanent eye damage

  • Injury to the cornea


References

  1. Eye Twitching. Cedars Sinai. Available at: https://www.cedars-sinai.org/health-library/diseases-and-conditions/e/eye-twitching.html. Last accessed: 17 July 2021.

  2. Eyelid Spasm and Twitching Treatment. American Academy of Ophthalmology. Available at: https://www.aao.org/eye-health/diseases/eyelid-spasm-twitch-treatment. Last accessed: 17 July 2021.

  3. Eyelid Spasms (Eye Twitching or Eye Twitch). Kellogg Eye Center. Available at: https://www.umkelloggeye.org/conditions-treatments/eyelid-spasms-eye-twitching-or-eye-twitch. Last accessed: 17 July 2021.

  4. Eye Twitching. Johns Hopkins Medicine. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/eye-twitching. Last accessed: 17 July 2021.

  5. Why Is Your Eyelid Twitching? AARP. Available at: https://www.aarp.org/health/conditions-treatments/info-2020/eye-twitching.html. Last accessed: 17 July 2021.

  6. Eye Twitching Causes & Treatments. Vision Center. Available at: https://www.visioncenter.org/conditions/eye-twitching/. Last accessed: 17 July 2021.

  7. Eye Twitching: What Causes It to Happen? Institute of Control of Eye Myopia in Children. Available at: https://www.myopiainstitute.com/eye-care/eye-twitching-what-causes-it-to-happen/. Last accessed: 17 July 2021.

  8. Benign Essential Blepharospasm. NORD. Available at:          https://rarediseases.org/rare-diseases/benign-essential-blepharospasm/. Last accessed: 17 July 2021.

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