Eye twitching: Why it happens

"The eyelid twitches because of intermittent bursts of electrical activity in the nerves innervating the eyelid muscles (orbicularis oculi) leading to intermittent involuntary contraction," explains Dr Loo Jing Liang, Head & Senior Consultant from the Neuro-Ophthalmology Department at Singapore National Eye Centre (SNEC), a member of the SingHealth group.

Eye twitching: How to stop

To prevent common eye twitching, try these simple measures:

  • Ensure adequate sleep and eye breaks

  • Reduce consumption of caffeinated drinks

  • Apply lubricating eye drops

  • Perform eyelid hygiene to remove excessive oil on the eyelid margin can help.
    When performing eyelid hygiene, you can use over-the-counter eyelid cleansers or use baby shampoo diluted with warm water and a cotton bud / pad to gently wipe your eyelid margin near the root of the lashes in a horizontal direction, twice a day.

​Eye twitching: 3 common causes

1. Eyelid myokymia

The most common type of eye twitching we see is eyelid myokymia. Most normal people will experience this at least once in their lifetime.

This is the sensation of eyelid “jumping". Some describe it as ”feeling a heartbeat “ below the eye. It affects only the lower or upper eyelid on one side. It is intermittent and can last for several days to weeks. It is usually precipitated by fatigue, eye strain, stress, too much caffeine or local irritative factors such as dry eyes or oily eyelids (meibomitis and blepharitis). This is almost always benign and usually resolves spontaneously or with conservative measures.

2. Hemifacial spasm

In hemifacial spasm, the person experiences intermittent, involuntary contraction of the muscles of one half of the face (the eyelid closes as if it is winking and the half the mouth is drawn upwards). Most cases are thought to be caused by compression of the facial nerve responsible for innervating the facial muscles on the same side, by a normal pulsating blood vessel in close proximity which have enlarged with age.

Rarely, in less than 1% of the time, the compression is due to a brain tumour compressing on the facial nerve. Hemifacial spasm does not resolve spontaneously.

3. Benign essential blepharospasm (BEB)

In benign essential blepharospasm (BEB), the patient experiences intermittent involuntary spasm and closure of both eyelids. Initially, there is increased frequency of blinking in response to bright light, wind or stress. This progresses to involuntary spasm or closure of both eyelids. If severe, it can interfere with the patient’s vision and performing of their everyday activities such as crossing the road.

Sometimes BEB can progress to involve other muscles of lower face and neck in a condition termed Meige Syndrome. In this condition, the patient may experience involuntary lip pursing, chewing or tongue movements etc. The term “essential” means no underlying cause and majority of the cases we see occur in isolation without any evidence of neurological or eye disease. However, blepharospasm have been reported to be caused by neurological conditions such as stroke and Parkinson disease etc. BEB rarely resolve spontaneously.

Eye twitching: When to see a doctor

If the twitching involves half of your face, or both eyes simultaneously and is persistent, do seek medical attention as it may be more than the usual eyelid myokymia.

For hemifacial spasm, a magnetic resonance imaging (MRI) is recommended to exclude a compressive lesion on the facial nerve on the same side.

For both hemifacial spasm and BEB, conservative measures rarely help. For hemifacial spasm, neurosurgery to move the offending vessel away from the facial nerve is the only way to treat the root of the problem. 

For both hemifacial spasm and BEB, botulinum toxin may be injected into the eyelid and facial muscles to relieve the spasm. However, repetitive injections are required as the effect of the injection will wear off, typically after 4-6 months.

Ref: L20

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