Eyelid twitching: Reasons, how to stop and superstition

Eyelid twitching can be graded according to the severity of spasms experienced by the individual. Following are some of the types of eyelid twitching:

Tics and twitches

These are the mildest forms of spasms, which are often just felt and can barely be seen. These are experienced for brief durations, usually during periods of stress. These spasms are so mild that they just feel like a gentle tug on the eye. They are essentially painless. These type of twitches do not hint towards any pathological condition and do not require any treatment. They can be experienced in either of the eyelids, most commonly in the upper.

Blepharospasm

If you commonly experience eye twitching, it is likely that the condition is chronic. This hints towards a condition called blepharospasm, in which, the spasm is strong enough to cause both the eyelids to shut momentarily. Blepharospasm relates to a more severe form of eyelid squeezing and requires treatment in most cases. The muscular spasms in this condition are so severe that they cause the eyelids to shut down for hours, but, this occurring is quite rare. If these symptoms are ignored, there is a slight risk of blindness. 

Meige’s syndrome

In some cases, eye twitching may occur due to an underlying syndrome, most commonly Meige’s. It is a rare neurological disorder, which is characterised by involuntary contractions of the facial muscles, tongue and the muscles surrounding the eyes. In addition to the classic symptoms of blepharospasm, Meige’s syndrome is also manifested by frequent blinking and irritation of the eye in response to several stimuli like bright light, air pollutants or even the wind. It may be unilateral (one side of face) or bilateral (both sides of face) and the affected individual may find it increasingly difficult to keep their eyes open.

The exact cause of eye twitching is unknown. When associated with blepharospasm, there may be a family history of eyelid spasm or it may be associated with a dry eye. Abnormal functioning of basal ganglion (cluster of brain cells) is known to be the cause for this condition.

Other than this, there are certain risk factors which precipitate eyelid twitching in healthy individuals. These are:

• Eye irritation, which may involve either the conjunctiva (membranes lining the eyelids) or the cornea (superficial layer of the eye)
• Fatigue
• Stress
• Insufficient quality or duration of sleep
• Excessive caffeine consumption
• Dryness of the eye
• Sensitivity to light
• Injury to the cornea of the eye
• Physical exertion
• Excessive intake of alcohol
• Certain medications like antipsychotic drugs and group of medications used to treat Parkinson’s disease, which increase the levels of dopamine also increase the risk of this condition. Studies performed on animal models even suggest a close relationship of blepharospasm with Parkinson’s disease but the evidence is not clear for humans.

In mild cases, the only symptom experienced is an involuntary spasm of the eyelids. It may involve one or both the eyes. In severe cases, when it is associated with blepharospasm, these twitches will be highly uncontrollable and may interfere with the daily activities of the person. These symptoms may increase in intensity for as long as the condition is not managed.

Following are the symptoms of twitching eyelids due to blepharospasm:

• Spasm in response to certain triggers like bright light or wind. Fatigue may also be a trigger in some.
• Involuntary shutting down of the eyes for a few minutes to a few hours
• Intense spasms that pull down the eyebrows towards the eyelids

These spasms are often more intense during the daytime as compared to the night, regardless of the presence or absence or bright light trigger.

There are no specific diagnostic tools or measures for the diagnosis of twitching eyes. So, forming a diagnosis lies in its symptoms. Medical and family history goes a long way in the diagnosis of blepharospasm. However, it is difficult to diagnose this condition individually due to its close resemblance to other disorders like ptosis of the eyelids.

Meige’s syndrome is usually diagnosable in the later stages of life, most commonly, in the seventh decade when the symptoms become apparent. Examination of the patient along with their medical history may be helpful in its diagnosis.

If otherwise non-symptomatic, eyelid twitching can be prevented by the following measures:

• Taking sufficient sleep
• Resting the eyes
• Avoiding stress with the help of stress management techniques like yoga and meditation
• Reducing the intake of alcohol and caffeine
• Cessation of smoking
• Avoiding exposure to bright lights
• Using eye lubricants to prevent dryness of the eyes
• Limiting screen time
• Knowledge of known triggers and their avoidance can also help in preventing eyelid twitching

Mild cases of eyelid twitching require no treatment and preventive measures may be enough to avoid future episodes. In some cases, it may become essential to diagnose the underlying cause or condition to determine the course of treatment. It is important to consult your doctor if:

• Eyelid twitching is persistent for more than a week
• The spasm is so intense that it causes the eyelid to shut
• There are additional symptoms like redness, pain, swelling of the eyes (it may be a sign of an eye infection in these cases)
• Drooping of the eyelids is experienced
• Twitching involves other parts of your face

Treatment of eyelid twitching due to stress or lack of sleep

This requires stress management and sleep cycle regulation. So, psychotherapy may be indicated along with other techniques. In some cases, sedatives (induce sleep) and anxiolytics (help in relieving anxiety) may be prescribed by the doctor. It is important to follow your doctor’s instructions with the dosage of these drugs and discontinue them after the prescribed time in order to avoid any side effects.

Treatment of eyelid twitching involving an eye infection

When other symptoms like redness of the eye, itching or irritation are present, it is indicative of an underlying infection. You may then take the following precautions:

• Avoid touching or rubbing the eye repeatedly
• Keep your eyes clean
• Wash your hands before touching the eyes
• Use prescribed eyedrops regularly
• Discontinue the use of contact lenses
• Avoid sharing items of personal use like towels, eye drops, etc
• Do not share eye cosmetics and avoid using them when your eyes are infected

Treatment of eyelid twitching due to blepharospasm

Blepharospasm can give rise to several complications if left untreated. So, it is important to seek medical attention at the earliest. According to the National Eye Institute, there is no specific treatment for blepharospasm, which can completely cure the condition, but its severity can be significantly reduced with the help of the following measures:

• Oral drug therapy
  The oral drug therapy for the treatment of blepharospasm comprises gamma-aminobutyric acid or GABA agents, which is a neurotransmitter in the brain responsible for reducing the excitability of the neurons. It is, thus, useful in the management of anxiety and has a sedative and an anxiolytic effect on the body.
  For the management of blepharospasm, GABA-A and GABA-B medications like benzodiazepine and baclofen are indicated, the latter being effective for reducing muscle spasms. But, the efficacy of these drugs is limited through the oral route and also has some side effects. So, these may not be commonly prescribed.

• Intramuscular drug therapy
  Botulinum toxin or botox agents are often used for the management of eyelid twitching. They are directly injected into the muscles of the surrounding area where they block the release of certain transmitters which may be responsible for twitching.
  Type A and type B formulations of botulinum toxin are commercially available and offer long-term effectiveness in the management of eyelid twitching. For the best results, booster doses are administered 2-3 weeks after the initial dose. However, dry mouth and constipation are two of the side effects of this therapy.

• Surgical therapy
  Surgical therapy for the management of blepharospasm involves myectomy procedures, in which the thickness of the eyelid or the eyebrow muscle is reduced or removed in order to manage severe symptoms unmanageable with prior treatment procedures. In some cases, repeated surgeries may be needed.

Eyelid twitching is usually episodic and holds an excellent prognosis (chances of improvement in symptoms) when not associated with an underlying condition.

In case of blepharospasm and Meige’s syndrome, gradual worsening in symptoms occurs until the condition is not treated. Oral therapy and injective measures often fail to treat severe cases of blepharospasm, suggesting the need for surgical measures, which are effective in 80% of the cases.

Overall, the prognosis of eyelid twitching is fair with a rare chance of blindness, in cases where the nerve is affected. It is the best to seek treatment at the earliest if symptoms are chronic.

India is a land of diverse superstitions. Eyelid twitching is no different. Interestingly, it is linked to good or bad omen, which is decided on the basis of the side of the eye. It is important that you do not fall for these superstitions and seek medical help if such symptoms occur repeatedly. Anyway, here is what the superstition revolves around: