En español | There it goes again. Most of us, at one time or another, have experienced eyelid twitches (also known as myokymia): mild, involuntary contractions of the orbicularis oculi muscle, located under the skin around the eyelid. Usually occurring on one side and in the lower lid, twitching tends to be short-lived, lasting a few seconds or minutes, but can recur over a few hours, days or longer.
Though these twitches can be annoying, for sure, they are usually nothing to worry about, says Eleanore T. Kim, M.D., a New York City-based ophthalmologist affiliated with NYU Langone Health: “Eyelid twitching is quite common, usually harmless, and usually goes away on its own.”
Stress, fatigue, caffeine and alcohol. “One thing I ask patients who complain of twitching is, ‘How much caffeine do you drink a day?’” Kim says. Indeed, downing a lot of caffeinated beverages (such as coffee, tea, soft drinks and energy drinks) can cause quivering. She notes that caffeine increases sympathetic nerve activity, which may lead to more stimulation of the eye muscle.
A few small lifestyle tweaks may prevent bothersome twitches — for example, getting enough shut-eye (aim for seven to eight hours a night), carving out some time to de-stress during the day (say, 10 minutes of deep breathing or a walk around the neighborhood), and cutting back on the amount of soft drinks, java or vino you consume.
Dry eye and inflammation. Twitching may accompany an irritating eye condition. Dry eye — particularly common these days, with so many of us working from home and spending a lot of time in front of a computer — is often associated with eyelid twitching. Those masks we’re wearing for protection during the COVID crisis can make things worse. If the mask you’re wearing doesn’t fit securely, the air you exhale can flow up and hit the surface of the eyes, which can dry out the tear film on the surface, thus exacerbating dry eye, says Andrew Iwach, M.D., the executive director of the Glaucoma Center of San Francisco.
An inflammation of the eyelid known as blepharitis, usually caused when tiny oil glands near the base of the lashes become clogged, can also cause twitching. “As we get older, the oil [produced in the glands] can get a little thicker and accumulate a bit on the lid margin,” Iwach says. That excess oil can also invite excessive bacterial growth and lead to infection.
If eyes feel dry, restore moisture by lubricating the surface of the eyes with artificial tears. Cleaning the lids each night, before bed, can prevent the oil glands from getting clogged. Iwach suggests using warm water and mild soap or baby shampoo or buying packaged pads infused with a gentle cleaning solution. A warm compress, placed over closed lids, can also help loosen excess oil. “If there’s an underlying infection, we may put patients on antibiotics,” Iwach says. You might also consider investing in a humidifier to add more moisture to the air inside your house during the dry winter months ahead.
Eye allergies. The eyes release histamine when they come in contact with an allergen (ragweed is a common nuisance in fall), causing them to water and itch. Twitching may occur because you’re rubbing your lids more often, thereby irritating the surrounding muscles, Iwach says. Try artificial tears or an eyewash to rinse away allergens on the surface of the eye or over-the-counter eye drops with antihistamines to temporarily relieve the itch and subsequent twitch.
Other possible triggers. Eyelid twitching can also be an unwelcome side effect of drugs (for example, medication taken for Parkinson’s disease or epilepsy).
When to seek help
Myokymia usually doesn’t require medical intervention. However, if you’re experiencing significant eye spasms — as opposed to mild flutters — they may signal a neurological disorder. Benign essential blepharospasm is a rare condition involving the muscles around the eye. The first symptoms include increased blinking, which gradually develops into full-on contractions of the muscles around the lid. In severe cases, people have a hard time keep their eyes open, says Kim, leading to serious vision impairment. The causes are unknown, though researchers suspect it is associated with malfunction of the basal ganglia, clusters of neurons within the brain that help control movement, among other things. The most effective treatment: injections of botulinum toxin (or Botox) into the lids to weaken the muscle that is contracting. The results slowly wear off after three to four months and will need to be repeated.
Hemifacial spasm is another neuromuscular disorder in which involuntary spasms of the muscles occur on one side of the face. More frequently affecting middle-aged or older women, it usually begins as twitching of the eyelid muscle, which gradually morphs into a complete closure of the eye. The condition may be caused by an irritation of the facial nerve (a blood vessel may be pressing against it). Botox, injected into affected areas, may relieve spasms. More severe cases may require surgery to relieve pressure on the nerve.
The bottom line: Book an appointment with your ophthalmologist if an eyelid twitch is persistent (still occurring after a few weeks); if your eyelid shuts when it twitches and you’re having trouble opening the eye; if your upper eyelid is droopy or completely closed; or if you’re seeing sudden changes or getting spasms on one side of your face.