Eye twitching is a repetitive, uncontrollable blinking or spasm of the eyelid, usually the upper lid.
Eye twitching (blepharospasm) usually affects the eye muscles of both eyes. If you have eye twitching, you may have an involuntary movement that recurs every several seconds for a minute or two.
Most people develop a minor eyelid twitch at some point in their lives. Although the cause is generally unknown, it may be associated with:
Fatigue
Stress
Caffeine
This minor form of twitch is painless and harmless. It usually goes away on its own. But it can be quite annoying. And that's especially true if the spasms are strong enough to cause the eyelids to completely shut and then reopen.
In some cases eye twitching is more than a temporary nuisance. Some people have spasms that occur frequently throughout the day. Symptoms can recur for days, weeks, or even months. That can cause a lot of emotional distress. It can interfere with quality of life.
In its most serious forms, which are relatively uncommon, eye twitching can become chronic. It can cause persistent winking and squinting. If it progresses to the point where you have difficulty keeping your eyes open, it can cause severe vision impairment.
Sometimes, eye twitching can be a sign of eye conditions such as
Blepharitis (inflammation of the eyelids)
Dry eyes
Light sensitivity
Pinkeye
Very rarely, it can be a sign of a brain or nerve disorder, such as
Bell's palsy
Dystonia
Parkinson's disease
Tourette's syndrome
Eye twitching can also be a side effect of certain medications. The most common offenders include drugs used in the treatment of psychosis and epilepsy.
Types of Eye Twitching
There are three common types of eye twitch
Minor eyelid twitch
Benign essential blepharospasm
Hemifacial spasm
Minor eyelid twitch is often associated with lifestyle factors, such as
Fatigue
Stress
Lack of sleep
Use of alcohol, tobacco, or caffeine
Minor eyelid twitch also can be caused by irritation of the surface of the eye (cornea) or the membranes lining the eyelids (conjunctiva).
Sometimes the cause of minor eyelid twitch cannot be identified. In almost all cases it is painless and harmless.
Benign essential blepharospasm usually develops in mid- to late-adulthood and gradually worsens. It affects about 20,000 to 50,000 Americans. It's twice as common in women as in men. It is not a serious condition but can interfere with your daily life in more severe cases.
Typically, benign essential blepharospasm starts with excessive blinking and/or eye irritation that may be triggered by:
Fatigue
Stress
Irritants such as bright light, wind, or air pollution
As the condition worsens, it may lead to an increased sensitivity to light, blurry vision, and facial spasms. In severe cases, the spasms can become so intense that the eyelids stay shut for up to several hours.
Researchers believe that benign essential blepharospasm may result from a combination of environmental and genetic factors. Although the condition is usually random, it sometimes runs in families.
Hemifacial spasm is quite rare and involves more than just the eyelid muscles. It also usually involves the muscles around the mouth. Unlike other types of eyelid twitching, it usually affects only one side of the face.
In most cases, hemifacial spasm is caused by an artery pressing on the nerve to the facial muscles.
Diagnosis of Eye Twitching
You should see an eye doctor if you have
Twitching that persists for more than one week
Twitching that completely closes an eyelid
Spasms that involve other facial muscles
Redness, swelling, or discharge from an eye
A drooping upper eyelid
If your doctor suspects that a brain or nerve disorder is responsible for eye twitching, he or she will examine you for other common signs. You may be referred to a neurologist or other specialist.
Treatment of Eye Twitching
In most cases, minor eyelid twitch will disappear without you even noticing if you get enough rest and/or reduce or eliminate your intake of alcohol, tobacco, or caffeine. Blepharospasm does not occur while sleeping.
If you have dry eyes causing irritation of the cornea or conjunctiva, treating it with over-the-counter artificial tears will often relieve minor eyelid twitch.
So far, doctors have not found a successful cure for benign essential blepharospasm. But several treatment options may reduce its severity.
The most commonly recommended treatment for benign essential blepharospasm is botulinum toxin (also known as Botox or Xeomin). It's approved for this use in both the U.S. and Canada. Botox is also commonly recommended for patients with hemifacial spasm.
When injected in very small quantities into the eye muscles, the drug may relieve spasms for several months. But the effect gradually wears off. Repeat injections are usually necessary.
In mild cases of benign essential blepharospasm, doctors sometimes recommend medications such as:
Clonazepam
Lorazepam
Trihexyphenidyl
These usually provide only short-term relief and have been found to help in only about 15% of cases.
Alternative treatments for benign essential blepharospasm include
Biofeedback
Acupuncture
Hypnosis
Chiropractic
Nutrition therapy
But the benefits of these treatments have not been established by scientific studies.
If other treatments fail, surgery is an option. About 75% to 85% of patients with benign essential blepharospasm benefit from myectomy. That's a surgical procedure in which some of the muscles and nerves of the eyelids are removed.
Also generally successful for patients with hemifacial spasm is a neurosurgical procedure to relieve the pressure of the artery on the facial nerve. While such surgeries usually produce permanent results, they can lead to serious complications. In addition, any side effects are likely to be permanent.
