Twitching Eyelids

Symptoms   Causes   Treatment   Self help discussion

Most of us have experienced a twitching eyelid when we are over-tired, have been at the computer or cell phone too long, feel anxious, over-stressed, or just plain frazzled. That occasional annoying little tic in one eye might be the beginnings of blepharospasm, or it might simply be an annoying warning . There's quite a bit you can do.

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Eye twitching is the involuntary twitching of an eyelid, caused by seventh cranial nerve disfunction. Recent neuroimaging research now indicates that it is actually due to functional and anatomic activity in several different brain regions, which accounts for the varied experiences of both the eye and nonmotor manifestations.¹ Usually it lasts just for a few minutes, hours, or days, but in severe cases may be chronic, and in rare cases, it may be difficult to open the eyes.

Certain nutrients such as magnesium malate chelate may help alleviate symptoms of blepharospasm.

Self Help

You can try supplementing with magnesium,^{2, 3} but you should check with your doctor if the condition is chronic. Because stress may be a contributing factor, sometimes paying attention to issues causing stress and self massage can be helpful.

• Massaging the cheek, jaw and gum muscles can sometimes bring immediate relief for mild cases.
  • If you feel inside your mouth, you'll find the masseter muscle, a hard muscle near the back which moves up and down vertically.
  • Use your pointer finger at the top end of the masseter muscle, next to the upper gum and begin pressing firmly checking for tender places.
  • Press any tender spots for about 30 seconds, not too hard, just as much as you can stand. More pain is not helpful.
  • Work your way around the top of this muscle, pressing any tender spots.
  • In the same way, find tender spots and press for 30 seconds along the upper back gum line.
  • Generally it will take not more than 3-4 days for relief.
• Massage in general may be helpful to reduce overall stress contributing to the eye twitching.
• A warm compress over the upper face and eyes will help to relax the muscles and relieve muscle tension. If you have myokymia, with swelling, the warm compress can help to reduce swelling.
• Other sensory tricks: try some of these, one at a time to see if they work for you.
  • Press fingers against temples, end of nose, or other facial location. It's different for each person.
  • Wear a tight headband or baseball cap.
  • Close your eyes and put your head back or look down.
  • Go to a dark place and sit quietly, not thinking of anything in particular. Don't try to relax; perhaps just notice your breathing.
  • Chew gum, whistle, hum, sing, suck on a straw.
  • Read aloud.
• If possible, avoid drugs that contribute to or aggravate blepharospasm.
• Notes on caffeine: logically, caffeine intake should increase eye twitch, but the research suggests an inverse relationship.¹⁰ Unsurprisingly, many researchers disagree.¹¹
• Stop smoking.
• Dark glasses are helpful for your light sensitivity.
• Make sure your computer setup uses proper ergonomics. Aim for an arm's length distance from the screen.
• Smart phone users: don't hold your phone close to your eyes - this aggravates eye strain. Aim for a minimum of 12-14".
• Use natural light if possible.
• Take steps to reduce chronic stress at your job, and manage your stress with meditation or yoga. Take a walk.

Complementary Treatment

Since mild blepharospasm may be related to stress, eye fatigue, or computer vision syndrome, addressing those issues can be helpful for many people.

• Consider nutrients to support eye health overall and address dry eye and computer vision syndrome issues.
• Acupuncture can be more effective than botox therapy. In a group of 30 patients half received botox and half received acupuncture. In both groups lower eyelid tension (LET), a measure used to diagnose blepharospasm severity, decreased, with slightly better results in the acupuncture group.⁴ Furthermore, some acupuncture techniques (Tonifying-Qi and Dredging-Meridian) are more effective than conventional acupuncture.⁵
• Self-help techniques can bring relief.

Conventional Treatment

Botulinum toxin is the approved medical treatment in the United States and Canada.⁶ It weakens the muscles by blocking the nerve impulses transmitted from the nerve endings of the muscles. It is injected into the masseter muscle (described in the massage technique above).

The benefits begin 1-14 days after treatment and lasts for an average of three to four months. The success rate is up to 90% in stopping the spasms (twitching).⁷

The side effects of this treatment may be drooping eyelids, blurred vision, and/or double vision. Side effects are usually short-term. Over an 18 to 29 year observation period (depending on the type of virus used, this treatment is considered safe. One patient in 69 tested positive for neutralizing antibodies against botulinum toxin A.⁸ Speak to your doctor for more details.

Drugs - no specific drug has been shown to be effective as of this time. Consult your neurologist for possible new medications.

Surgery - as a possible last resort, protractor myectomy is most effective for severe cases. This procedure removes the muscles responsible for closing the eyelids. Blepharoplasty is a related surgery.⁹

Resources & Footnotes

Benign Essential Research Foundation

1. Defazio G, Hallett M, Jinnah HA, Conte A, Berardelli A. Blepharospasm 40 years later. Mov Disord. 2017 Apr;32(4):498-509.
2. Ploceniak, C. (1990). Bruxism and magnesium, my clinical experiences since 1980. Revue de Stomatologie et de Chirurgie Maxillo-faciale.
3. Good Health, NZ. (2014). "10 signs that you're magnesium deficient"
4. Bao FF, Li QS, Zhang ZY, Xiang MH. (2019). Treatment Effects of Botulinum Toxin Injection and Acupuncture in Blepharospasm Assessed by the Change in Lower Eyelid Tension. Curr Eye Res. Jun;44(6):679-683.
5. Liu J, Xu H, Zhang R. (2014). [Efficacy Observation of Acupuncture Method of Tonifying-Qi and Dredging-Meridian for Blepharospasm]. [article in Chinese]. Zhongguo Zhen Jiu. Jan;34(1):37-40.
6. Yen MT. (2018). Developments in the Treatment of Benign Essential Blepharospasm. Curr Opin Ophthalmol. Sep;29(5):440-444.
7. Jochim A, Li Y, Gora-Stahlberg G, Mantel T, Berndt M, et al. (2017). Altered Functional Connectivity in blepharospasm/orofacial Dystonia. Brain Behav. Dec 18;8(1):e00894.
8. Jochim A, Meindl T, Huber C, Mantel T, Zwirner S, et al. (2020). Treatment of Blepharospam and Neige's Syndrome with Abo- and onabotulinumtoxinA: Long-Term Safety and Efficacy in Daily Clinical Practice. J Neurol. Jan;267(1):267-275.
9. Clayman M, King K, et al. (2017). Management of Essential Blepharospasm. Eplasty. June.
10. Siokas V, Kardaras D, Aloizou AM, Liampas I, Papageorgiou E, et al. (2020). Polymorphisms in Patients with Blepharospasm. J Mol Neurosci. Sep;70(9):1370-1375.
11. Defazio G, Abbruzzese G, Aniello MS, Bloise M, Crisci C, et al. (2011). Environmental risk factors and clinical phenotype in familial and sporadic primary blepharospasm. Neurology. Aug 16;77(7):631-7.