Eye Twitching (Blepharospasm)
What is Eye Twitching?
Eye Twitching, also known as blepharospasm or myokymia, is a sudden, involuntary movement of the eyelid; it is also referred to as an eye muscle spasm. These spasms often occur in stressful situations or when the affected individual has gone too long without sufficient rest. Anyone who suffers chronic eye twitching can tell you how maddening it is—sometimes you almost feel as though you could cheerfully gouge your own eye out with a spoon if that would bring you a moment’s peace! Treatment methods may vary, depending on the cause of the eye twitch, but in some cases the solution may be as simple as cutting back on caffeine or getting enough rest (see below for more detail about causes and treatments).
The term blepharospasm really applies to any abnormal blinking or involuntary twitching of the eyelids caused by uncontrolled contractions of the muscles around the eyelids (dystonia). Blepharospasm is also associated with abnormal function of the basal ganglion, the part of the brain that is responsible for controlling the muscles, and which some scientists believe may be the part that is affected by diseases such as Parkinson’s. In rare cases, heredity can also play a role in the development of blepharospasm.
Some people experience twitching underneath the eye; others experience it in the upper eyelid. Eye twitching can afflict either the right or left eye. Blepharospasm may be associated with dry eyes, Tourette’s syndrome, or various neurological problems. In general, patients experiencing blepharospasm have normal eyes, and any disturbance in their vision is due to the forced closure of the eyelids. Blepharospasm should not be confused with ptosis, or drooping of the eyelids, which may be caused by a weakness or paralysis of the muscle in the upper eyelid. Minor eye twitches usually do not worsen. If they do worsen or persist, it is important to seek the advice of an eye-care professional.
Blepharospasm usually starts with abnormal or excessive blinking accompanied by general eye irritation. Early on, the excessive blinking may only be a result of exposure to bright lights, fatigue, or stress. The frequency of the eye spasms may increase throughout the day. Sometimes the eye spasm may resolve during sleep and not occur again until you have been awake for many hours. As the condition worsens, the spasms tend to get stronger and may even result in the eyelids being tightly shut for a few hours at a time, making it impossible to see.
Spasms that cause twitching on one side of the face are known as hemifacial spasms. These are typically due to irritation of the facial nerve. This type of spasm necessitates a visit to your family doctor, who may refer you to a neurologist in order to determine the cause of your spasm and what treatment might be appropriate.
What Causes Eye Twitching?
The exact causes of eye twitching are unknown, but it is believed to be related to an abnormal functioning of certain nerve areas located at the base of the brain. These nerve areas control the coordination of muscle movements. Sometimes symptoms of dry-eye occur right before or along with the eye twitching. Some research indicates that dry eyes are a trigger for blepharospasm. Eye twitching can run in families, or it can be caused by the side effects of certain medications, such as those used to treat Parkinson’s disease.
Other common eye twitch causes include:
- Irritation of the Cornea or Conjunctiva
- Fatigue/Lack of sleep
- Prolonged staring at a computer screen or television
- Excessive caffeine intake (e.g., coffee, tea, caffeinated sodas)
- Nervous system disorders
As always, we recommend that you consult your doctor to find the real cause of your eye twitch.
Eye Twitching Symptoms
Symptoms of eye twitching may include:
- Difficulty keeping eyes open; may last for several hours
- Uncontrolled winking, blinking,or squinting that may come and go periodically throughout the day and occurs more frequently during the day than at night
- Sensitivity to light (photophobia)
- Blurry vision; duration varies from person to person depending on the severity of the disorder
Diagnosing an Eye Twitch
If you are experiencing a twitching eye, it may be best to contact your eye doctor for a proper diagnosis and possible treatment. During your initial visit, your doctor will ask you questions about your symptoms. He or she will want to know how often the twitch occurs and how long it lasts, as well as other medical information about you and your family. After the discussion, he or she will give you a complete eye examination. Typically this is all that is needed to diagnose blepharospasm. Once diagnosed, a treatment plan (if necessary) will be created and executed.
When to Contact Your Eye Doctor
Contact your primary care physician, eye care professional, or neurologist if:
- Eye twitching lasts more than one week
- Twitching completely closes eyelid and prevents normal vision
- Twitching spreads to other parts of your face
- You experience redness, swelling, and discharge from your eye
- Upper eyelid is drooping
How to Treat an Eye Twitch
There are three basic approaches to the treatment of blepharospasm: drug therapy, surgery, and supportive or preventative therapy. Drug therapy for eye-twitching is a somewhat unpredictable type of treatment that does not always produce long-lasting results. Some drugs work for some people and not for others. Arriving at a satisfactory treatment regimen takes a great deal of patience and requires the direct supervision of a neurologist.
Before embarking upon a surgical treatment, some doctors will suggest a trial of injection of a neuromodulator such as botulinum. Such treatments, which are often quite effective and safe, are administered through a few tiny injections of the highly purified protein into the muscle either above or below the eye to block the nerve impulses that trigger eye twitching. Neuromodulator injections are a simple, quick, minimally invasive treatment that can deliver dramatic results for patients suffering from blepharospasm. If neither drugs nor injections are successful, then surgery may be considered. In general, the benefits of neuromodulator injections begin to appear within two weeks of treatment and last an average of three to four months. Ninety percent of people who undergo neuromodulator injections obtain complete relief, but most people need to repeat treatment every two to three months.
In general, the approach to the treatment of blepharospasm varies with its severity. Preventative measures are important. Since stress causes almost all muscle problems to worsen, including blepharospasm, it is important to minimize and avoid stress. Whether this means embarking upon stress-management through cognitive therapy, occupational therapy, or other types therapy such as support meetings, these methods of developing and improving coping mechanisms should be explored.
Mild Eye Twitching
A mild eye twitch will usually go away on its own. Just cut down on stress and get plenty of rest. Decrease caffeine intake by drinking less coffee, tea, or caffeinated soda. Drinking a lot of water should help; tonic water in particular acts as a nerve-blocker. You can also try holistic methods such as breathing techniques, meditation, yoga, or counseling to help reduce stress.
Severe Eye Twitching
Medication may help, depending on the situation. When medication is prescribed it is usually to relax muscles; some medications work better than others. Medications that may be prescribed include Valium, Cogentin, Parlodel, Symmetrel, Lioresal, Tegretol, Artane or Klonapin.
Neuromodulator injections can sometimes help. Surgery is a last resort, and should be considered only for the most severe cases—i.e., those that hamper vision—or for patients who do not respond to medications and non-surgical methods of treatment. This is due to a fairly high rate of complications involving damage to the nerves that control eyelid movement when surgery is performed.
Nutritional supplements may also have a role in the treatment of eye twitching. There are not currently any good, controlled studies to support this form of treatment, but there is anecdotal evidence that they may work. The chart below lists nutritional supplements that may benefit someone who is suffering from constant or recurrent eye twitches. Please consult with your eye care professional before trying any of the following:
|Supplement||Directions for Use||Comments|
|Calcium||Take 1,000 mg per day||Good for nerve function|
|Folic Acid||Take 400 mcg per day||Good for proper nerve-cell production|
|Phosphorus||Take 800 mg per day||Good for proper nerve-cell growth|
|Potassium||Take 2,500 mg per day||Rebalances the nerves|
|Vitamin B complex||Take 100 mg per day||Good for stress|
|Vitamin B5||Take 100 mg per day||Improves the body’s resistance to stress|
|Vitamin C with bioflavonoids||Take 500 mg every three hours, up to four times per day||An antioxidant; should be used in powdered buffered ascorbic acid form|
Eye Twitching — Preventive Measures
There are several things you can do to reduce the twitching in your eye each day. In most cases, eye twitching is related to stress or emotional tension. In general, preventive measures can include:
- Stress management: keep stress under control
- Get plenty of sleep to keep eye muscles rested
- When engaged in vision-intensive activities such as computer work, take frequent breaks to give your eyes a rest
- Limiting caffeine intake
- Relaxation techniques such as yoga or meditation
Complications of Eye Twitching
Complications of eye twitching are very unusual, but may include:
- Side effects from Neuromodulator treatment: drooping eyelids, blurred vision, double vision, excessive tearing
- Side effects or complications of surgery
- Injury to the cornea (rare)
- Permanent eye damage (rare)
Talking to Your Eye Doctor
Here are some questions to ask your eye-care professional about eye twitching:
- What is causing my eye twitching?
- What can I do to prevent it?
- How often do you treat patients with this problem?
- How effective do you think Neuromodulator injections are?
- How long will my appointment take? Will I need to rest for the remainder of the day or can I return to school/work?
- What additional symptoms may appear? If any do, how long should I wait to contact you again?
- How often should I schedule follow-up visits?
- J. Anshel, MD. “Smart Medicine for Your Eyes- A Guide to Natural, Effective, and Safe Relief of Common Eye Disorders” (SquareOne Publishers, 2011) 166-168 MDConsult. Blepharospasm. http://www.mdconsult.com/das/patient/body/240457726-3/1154240764/10068/10327.html F.A. Davis. “Taber’s Cyclopedic Medical Dictionary” Edition 21 (F.A. Davis Company, 2009) 279
- MDConsult. Blepharospasm. http://www.mdconsult.com/das/patient/body/240457726-3/1154240764/10068/10327.html
- F.A. Davis. "Taber's Cyclopedic Medical Dictionary" Edition 21 (F.A. Davis Company, 2009) 279