Eyelid twitch happens when there is involuntary movement and spasm in the eyelids.
What are the different types of eyelid twitching, and how can they be treated?
There are three main types of eyelid twitching and they vary in severity.
Eyelid Myokymia
Most common type of twitching – happens to most people at some point in time:
- Affects only the eyelid
- Can involve either the upper or lower lid, but usually only one eye at a time
- Usually goes away spontaneously after days or weeks
- Is not a sign of a serious health problem
The cause is unknown, but may be triggered by:
- Alcohol intake
- Excess caffeine
- Fatigue
- Stress
- Dry eyes or oily eyelids leading to irritation of the eye surface
- Wind or air pollution
Treatment
- Lifestyle changes: improve sleep patterns, decrease caffeine or alcohol intake
- Use of lubricating eye drops
- Eyelid hygiene
Benign Essential Blepharospasm (BEB)
This is a movement disorder of the eyelids that causes uncontrolled blinking, squeezing and eyelid closure in both eyes. It occurs in middle age and affects women more than men.
The exact cause is unknown but may be due to abnormal functioning of the basal ganglia, a part of the brain that help coordinate our movements.
Symptoms
- Starts with increased blinking of both eyes
- May progress to frequent spasms of the eyelids
- Eyelids may be squeezed shut, lasting from seconds to minutes. This can interfere with the patient keeping his/her eyes open to do ordinary tasks such as walking and reading
- May be worsened by certain factors e.g., dry eyes, oily eyelids, bright light, stress, social interaction, etc.
BEB can be distinguished from eyelid myokymia by the following features:
- Both eyes are involved
- Frequent blinking
- Uncontrollable eye closure
- May have spasm of the lower face and neck muscles, with abnormal movements of the mouth seen
Treatment
Botox (botulinum toxin) injection (See section under HFS)
Hemifacial Spasm (HFS)
This is a condition whereby the patient experiences involuntary spasm of the muscles of half the face. Middle-aged men and women are affected equally.
The cause may be related to irritation of the facial nerve by a normal blood vessel lying close to it in the brain.
Symptoms
During a spasm, the eye on the side of the HFS closes and the corner of the mouth tightens and pulls upwards
Hemifacial spasm can be distinguished from BEB and eyelid myokymia by the following features:
- Only affects one eye
- Half the face is affected
Tests
MRI scan may be able to identify the contact or compression of the facial nerve by the offending blood vessel in the brain
Treatment
- Botolinum toxin (Botox) injection
- Considered to be the most effective treatment
- Does not treat the root of the problem
- Injections relax muscles that control eyelid movement, helping to relieve any spasms
- Takes effect about 4-5 days after injection
- Effect usually lasts 3-6 months, and injections can be repeated
- Anaesthetic cream is applied to your skin prior to the injections in order to minimise discomfort
- If this is your rst injection, your doctor may review you in two weeks to assess if the injected dose is suitable for your needs. It may take a few sessions to achieve the optimal dose for you
- Side effects of Botox
- Mild bruising at injection sites
- Dry eyes (common)
- Incomplete closure of the eye
- Droopy upper eyelid (uncommon)
- Double vision (uncommon)
- Side effects in other parts of the body e.g., swallowing, speaking or breathing (very rare)
- Side effects of Botox treatment around the eyes relate to Botox leaking into surrounding muscles not intended to be weakened. These usually disappear by 3-6 months.
- Surgery
- Treats root of the problem by removing the contact between the facial nerve and the offending blood vessel
- This procedure is known as microvascular decompression and involves implanting a small sponge between the facial nerve and the irritation-causing blood vessel
- It is performed by the neurosurgeons under general anaesthesia
