Eye Twitching and Eyelid Twitches

Eye twitching, eyelid tics and spasms are pretty common. Usually only the bottom lid of one eye is involved, but the top eyelid also can twitch. Most eye twitches come and go, although they can last for weeks or even months.

I once received an e-mail from a patient's wife, who told me her left lower eyelid had been twitching for several weeks, and it was driving her crazy. Could I help?

To find a solution for twitching eyes, we needed to determine the underlying cause of this annoying problem. Called myokymia in doctor lingo, these rippling muscle contractions in an eyelid can be triggered by:

• Stress
• Tiredness
• Eyestrain
• Caffeine
• Alcohol
• Dry eyes
• Nutritional imbalances
• Allergies

Almost all sudden-onset eyelid twitching is benign, meaning the condition is not serious or a sign of a medical problem. However, this kind of eye twitching also can be hard to treat. The only option for making the twitching stop may be to figure out the cause and deal with it.

More serious forms of eyelid twitching are caused by neurological conditions such as blepharospasm or hemifacial spasm. These conditions are much less common and should be diagnosed and treated by an eye doctor.

Stress: While we're all under stress at times, our bodies react in different ways. Eye twitching can be one sign of stress, especially when it is related to vision problems such as eye strain (see below). Reducing the cause of the stress can help make the twitching stop.

When your eyelid is twitching, you may feel that everyone else can see it! But usually the spasm is so subtle that it goes unnoticed by others.

Tiredness: A lack of sleep, whether because of stress or some other reason, can trigger eyelid spasms. Catching up on your sleep can help.

Eyestrain: Vision-related stress can occur if, for instance, you need glasses or a change of glasses. Your eyes may be working too hard, triggering eyelid twitching. Computer eye strain from computer use is also a very common cause of vision-related stress.

If your eyelid twitching is persistent and very annoying (like the problem experienced by my patient's wife), you should have an eye exam, because you may need vision correction. If you spend a lot of time on the computer, you also should consider talking to your eye doctor about special computer eyeglasses.

Caffeine and alcohol: Many experts believe that too much caffeine and/or alcohol can trigger eye twitches. If your caffeine (coffee, tea, soda pop, etc.) and/or alcohol intake has increased, cutting back is worth a try.

Dry eyes: More than half the older population experiences dry eyes, due to aging. Dry eyes also are very common for people who use computers, take certain medications (antihistamines, antidepressants, etc.), wear contact lenses and consume caffeine and/or alcohol. If you are tired and under stress, you also may develop dry eye. It's best to see your eye doctor for a dry eye evaluation, because many treatments are now available.

Nutritional imbalances: Some reports indicate a lack of certain nutritional substances, such as magnesium, can trigger eyelid spasms. Although these reports lack scientific evidence, I can't rule this out as a possible cause of eyelid twitching. If you suspect a nutritional deficiency may be affecting you, however, I suggest talking this over with your family doctor for expert advice rather than randomly buying over-the-counter nutritional products.

Allergies: People with eye allergies can have itching, swelling and watery eyes. When eyes are rubbed, this releases histamine into the lid tissues and the tears. This is significant, because some evidence indicates that histamine can cause eyelid twitching.

To offset this problem, some eye doctors have recommended antihistamine eye drops or tablets to help some eyelid twitches. But remember that antihistamines also can cause dry eyes. It's best to work with your eye doctor to make sure you're doing the right thing for your eyes.
 

In rare cases, some eye twitches just don't go away. Some of these types of twitches can be successfully treated with Botox injections that help stop muscle contractions. See your eye doctor for proper diagnosis and treatment if the twitching affects half your face or your entire eye, causing the lids to clamp shut.

So, what caused my patient's wife to have eyelid twitching? The problem turned out to be a combination of dry eyes and an incorrect contact lens prescription. Luckily, I was able to solve her annoying problem by prescribing new bifocal contacts made of a material designed specifically for people with dry eyes.