Eye Twitching (Myokymia) – Why the Eyelid Jumps and When to Get It Checked

Your eyelid jumps on its own, again and again, and sometimes this goes on for days. This kind of eyelid twitching – in medical terms eyelid myokymia – is one of the most common eye complaints, and most people will experience it at some point. It is bothersome and sometimes embarrassing, but almost always benign, and it goes away on its own. This page explains what causes it, what you can do, and which signs separate a harmless twitch from a condition that is worth having examined.

What eyelid myokymia is

Myokymia is a small, involuntary contraction of fibers in the ring-shaped muscle that closes the eyelid. It feels like a flutter, a quiver or a “jump” of the eyelid, and you can often see it in the mirror as a gentle ripple under the skin. To the people around you it is usually barely visible.

The typical features:

• Usually in one eye at a time.
• Most often in the lower eyelid, but the upper eyelid can twitch too.
• Gentle contractions that do not close the eye and do not interfere with seeing.
• It comes in waves: a few seconds of twitching, a pause, and again – over hours or days.
• Vision is normal, and the eye does not hurt.

This kind of twitching is not a sign of eye disease and does not harm vision. In most cases it has no single clear cause, but at least one trigger can almost always be identified.

Why the eyelid twitches

The common triggers are part of modern life:

• Stress and anxiety – perhaps the most common trigger. The twitching often appears during exam periods, a heavy workload or personal pressure.
• Fatigue and lack of sleep.
• Caffeine – coffee, energy drinks, tea and cola drinks in large amounts.
• Alcohol and nicotine.
• Eye strain and long hours in front of a screen, especially without breaks.
• Irritation of the eye surface or the eyelids – dryness, eyelid inflammation, a foreign body, wind, air pollution or bright light.
• Certain medications – in isolated cases the twitching starts after a new medication. If that is the case, ask the doctor who prescribed it, and do not stop treatment on your own.

How long it lasts

In most cases the twitching goes away on its own within a few days, and sometimes it lasts a week or two or longer. It can disappear and come back during another stressful period. Twitching that lasts more than a few weeks is not necessarily dangerous, but it is a good reason to get checked – see below.

What you can do at home

There is no drop or pill that stops ordinary myokymia. Treatment is mainly about removing the triggers:

• Get enough sleep, and try to keep regular sleeping hours.
• Cut down on caffeine, and notice whether there is a link between your cup of coffee and the twitching.
• Cut down on alcohol and smoking.
• Take short breaks from the screen, blink fully and look into the distance from time to time.
• Deal with stress in a way that works for you – exercise, walking, short breaks during the day.
• If your eyes are also dry, burning or irritated – lubricating drops (artificial tears) may ease the irritation. For what you can buy on your own and when you need a doctor, see Over-the-counter eye drops.
• If it feels like something is in your eye – do not rub it. A foreign body or a scratch irritates the eye and needs a different approach; see Corneal abrasion.

When the twitching keeps coming back, it helps to note down for a few days when it appears – after a short night, after your morning coffee, at the end of a long day at the computer. Often the pattern becomes clear within a week, and it is easier to know what to cut back on.

Most important of all: know that it is almost always benign. Worrying itself increases stress, and stress increases the twitching.

When it is no longer “just a twitch”

There are a few other conditions that sometimes start as eyelid twitching but behave differently. They are much less common, and they are the main reason to have twitching that does not go away examined.

Blepharospasm (eyelid spasm) – a condition in which both eyes close forcefully and involuntarily. It sometimes starts as increased blinking and irritation, and over time the spasms become stronger and more frequent, until it is hard to open the eyes. It usually appears in midlife, is more common in women, and disappears during sleep. It originates in the brain’s control of movement, not in the eye itself.

Hemifacial spasm – spasms on one side of the face, which usually start around the eye and spread to the cheek, the corner of the mouth and sometimes the neck. Unlike blepharospasm, they can also occur during sleep. The common cause is a blood vessel pressing on the facial nerve where it leaves the brainstem, so the evaluation usually includes an MRI.

Twitching that spreads to other facial muscles, or that comes together with facial weakness, a drooping eyelid, double vision or other neurological signs – requires an evaluation, and sometimes brain imaging. This is rare, and in such cases there are usually other signs besides the twitching.

What the ophthalmologist checks

The diagnosis of myokymia is clinical – based on the history and the examination, without blood tests or scans. The ophthalmologist looks at the eyelids and their movement, uses a slit lamp to examine the eye surface, the cornea and the eyelid margins to identify dryness, eyelid inflammation or a foreign body irritating the eye, and checks vision.

The twitching does not always appear during the examination itself. So it is a good idea to record a short video on your phone when it happens, and to bring a list of the medications you take – both help distinguish myokymia from another type of spasm.

If the twitching does not behave like typical myokymia – in both eyes, with forceful closing of the eye, or with involvement of the facial muscles – you will be referred for a neurological or neuro-ophthalmological evaluation, and an MRI if needed.

When the twitching does not go away

In most cases nothing more than an explanation and removal of the triggers is needed. When myokymia lasts a long time and is very bothersome, botulinum injections into the eyelid muscle are sometimes considered. The treatment is given by a doctor who specializes in it, and its effect usually lasts a few months. Botulinum injections are also the accepted treatment for blepharospasm and hemifacial spasm, where treatment continues over the long term and is planned after a full evaluation.

When to get checked

You can schedule a regular appointment, without going to the emergency room, when:

• The twitching does not go away after a few weeks.
• The eyelid closes completely with each contraction, or it is hard to open the eye.
• The twitching appears in both eyes, or spreads to the cheek, the mouth or other parts of the face.
• The eyelid droops, or the area feels weak or stiff.
• The eye is red, swollen or has discharge – see also Red eyes.

Go to the emergency room immediately when sudden weakness or drooping on one side of the face, double vision, a sudden drooping eyelid or a drop in vision appears. For more on telling urgent from non-urgent problems, see Urgent eye problems.

Prof. Michael Mimouni, Director of the Cornea Unit at Rambam, sees patients with problems of the cornea, the eye surface and the eyelids at his clinics in Herzliya Pituach and Haifa. During the examination we check whether something in the eye itself is irritating the eyelid – dryness, eyelid inflammation or a foreign body – and distinguish between benign myokymia and a condition that should be referred for further evaluation. Get in touch to schedule an examination. For other common eye problems, see Eye diseases.

The information on this page is general and is not a substitute for an examination and personal medical advice. Diagnosis and treatment decisions are made only after a complete eye examination. With sudden facial weakness, double vision or a sudden drop in vision, go to the emergency room immediately.