Eyelid Twitches

Q: My left eyelid twitches most of the time during the day. What is going on, and what can I do about it?

A: Eyelid twitches are spontaneous and uncontrolled spasms of the muscles that move the eyelid. They are usually more annoying than serious and may be triggered by factors such as overwhelming stress or fatigue. While eyelid twitches tend to stop on their own, a family doctor or ophthalmologist should evaluate any twitches that spread to other parts of the face, affect vision, or continue for more than two weeks.

The spectrum of triggers

While the exact cause for eyelid twitches may not be found, certain common triggers can contribute to the onset of these temporary and quick bursts of muscle spasms. 

• Stimulants from products such as caffeine, medications or substances of abuse
• Lack of restful sleep
• Stress or anxiety
• Alcohol and/or smoking
• Eyestrain due to a variety of reasons, including prolonged focus while on the computer, reading, watching television, or bright lights
• Dry eyes
• Environmental allergies, which may irritate the eyes

There is also the potential for eyelid twitches to occur as a result of an eye infection (bacterial conjunctivitis) or an irritation and inflammation of the eyelids known as blepharitis. Additionally, neurologic disorders may contribute to the spasms. These include cervical dystonia, meige syndrome, Parkinson's disease and dysfunction of a facial nerve.

To ensure that a more serious medical concern is not contributing to eyelid twitches, a medical evaluation should be completed.

An array of symptoms

Symptoms are variable and range from subtle movements to powerful contractions of the eyelids. These motions may disrupt vision by causing objects to move or oscillate, and in extreme cases obstruct vision by forcing the eyelids to close. They commonly affect the lower lid of one or both eyes, but spasms of the upper lids can also occur as they fire-off on a random basis for days, weeks or even months. If the twitching is persistent, affects both eyes and continues for many months, it may be due to a condition known as benign essential blepharospasm.

Is there a cause for concern?

While all that jumping and twitching of the eyelids is usually temporary and benign, it's best to make sure they are not the result of another, more concerning medical condition. Helpful information that you can provide your physician includes but is not limited to:

• When did the twitches begin (days, weeks or months prior to the visit)?
• When do they occur (only while you are awake, tired, stressed)?
• How long do they last (seconds, minutes, hours) or are they continuous and persist while you are awake?
• Have often do they twitch (daily, a few times per week, monthly)?
• Do you have any eye symptoms such as pain, redness or discharge?
• Are you currently taking any medications, supplements or herbal preparations? If so, when did you begin taking those products?
• Do the twitches affect your vision?
• Do the twitches affect any other area of your face or body?
• Has any family member been affected with eyelid twitches?

Next, a thorough examination of your eyes and their surrounding muscles would be performed. Your physician will check for any signs of eye infection, inflammation, irritation or dryness, as well as observe your eyelids for any fine and/or intermittent contractions. If twitches do occur, a slight and gentle pull of the eyelid may improve the symptoms.

Treatment options

The approach to soothing eye twitches depends upon many factors, including their potential cause, as well as their impact on your everyday quality of life. Treatments range from simple measures you can do yourself to medication interventions. In severe cases, surgery may be needed. Treatment options include the following:

• Improving the quality and consistency of sleep
• Gentle eyelid cleansing
• Stress reduction techniques such as biofeedback
• Reduction of eyestrain (i.e., new eyeglasses, wearing sunglasses outside)
• Periodic use of warm compresses to the eyelids
• Decrease or stop the use of stimulant containing products
• Use of lubricating eye drops for dry eyes (only after evaluation by your physician)
• Treatment of unrelenting and/or vision affecting twitches with botulinum toxin A, or Botox

Fortunately, most twitches tend to disappear just as mysteriously as they began: suddenly and out of nowhere.

To get the help you need, visit your physician. Also, take charge of your health with information from sources such as the American Academy of Family Physicians and the National Institute of Neurological Disorders and Stroke.

More About Eye Care on MSN Health & Fitness:

• 10 Tips to Protect Your Eyes
• From 20/80 to 20/20
• Talk About It: Eye Problems

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)