What is Eyelid Myokymia?
Eyelid myokymia is the most common form of facial myokymia. This condition leads to small, continuous, rippling contractions in the affected muscle, usually the one around the eyes called the orbicularis oculi muscle. These involuntary contractions often affect one eyelid – typically the lower one – occasionally lasting from a few seconds to hours. Sometimes these contractions can become chronic and go on for several days to weeks before stopping. Interestingly, being female and cold weather have been identified as risk factors for chronic eyelid myokymia. In rare instances, both the upper and lower eyelids can be affected simultaneously.
In terms of the anatomy of the eyelid, it is made up of three layers. The outer layer consists of the skin and the orbicularis oculi muscle. The next layer is a combination of orbital septum, fibro adipose tissue and orbital fat. The innermost layer contains the tarsal plate, the retractors, and the conjunctiva.
The orbicularis oculi muscle is a surface muscle that controls the closing of the eyelids. Its fibers are attached directly to the skin of the eyelids. This muscle has three sections – one in front of the tarsal plates, one above the orbital septum, and one stretching from the eyebrows to the cheek. It is controlled by nerves from the facial nerve.
The facial nerve is responsible for controlling various facial muscles. It starts its journey from the brain stem and divides within the parotid gland (a salivary gland near the ears) into two parts. The nerves from these two divisions supply the orbicularis oculi muscle to facilitate its movement.
What Causes Eyelid Myokymia?
The exact reasons why eyelid myokymia (uncontrolled twitching of the eyelid) occurs are not completely known. It generally tends to happen in healthy individuals and is often brought on by factors like tiredness, worry, stress, physical activity, and drinking caffeine.
Certain medications such as topiramate, clozapine, gold salts, and flunarizine might trigger eyelid myokymia. But myokymia caused by medication is rare. Other possible causes that have been reported include multiple sclerosis and autoimmune diseases, which are conditions where the body’s immune system mistakenly attacks healthy cells, and brainstem conditions like pontine glioma, which is a type of brain tumor.
Risk Factors and Frequency for Eyelid Myokymia
There isn’t a lot of information available about how often eyelid myokymia, a condition involving involuntary eye twitching, occurs. However, it’s common in healthy young people. It’s frequently called the “medical students’ disease” because it often affects medical students, especially when they’re stressed.
Signs and Symptoms of Eyelid Myokymia
Myokymia, or twitching of the lower eyelid, is a common condition. When you see a doctor about this, they will ask about your overall health and lifestyle. They might ask whether you smoke, how much caffeine you consume, and what medications you’re taking, as these factors could influence the twitching.
During the physical examination, the doctor might notice small muscle movements in your eyelid. These movements are usually more noticeable to you than to anyone else. Interestingly, pulling the eyelid can often reduce the twitching. In rare cases, the twitching may cause your eye to move slightly, similar to a condition called nystagmus. The doctor might tap on the area where the twitching is happening to confirm it’s myokymia.
Testing for Eyelid Myokymia
When it comes to choosing the right type of imaging for persistent myokymia (muscle twitching), the decision depends on the patient’s symptoms and what doctors think might be causing them. Routine brain scans often aren’t needed because they don’t usually reveal anything useful. For instance, an American study found that, out of 15 patients who had CT scans (a specialized type of X-ray) or MRIs (which use magnetic fields and radio waves to create images), 13 showed no masses or other issues with the facial nerve or brainstem.
However, when an imaging scan is required, the best choice is often an MRI scan with a special dye called gadolinium contrast. This type of scan provides images of the whole pathway of the facial nerve. There are several parts to this scan, including:
- An MRI of the brain to provide images of the nerve’s central pathways.
- An MRI of the base of the skull and the parotid glands (the salivary glands in front of the ears) to check for masses associated with the facial nerve outside the brain.
- An MRI of the bones around the ears to evaluate for inflammation, abnormal meningeal (protective brain and spinal cord coverings) conditions, and the extent of disease along the nerve inside these bones.
In cases where a CT scan is more suitable or necessary due to a patient’s inability to have an MRI, it can be used in combination with the MRI, or as an alternative. Also, an ultrasound (which uses sound waves to produce images) can be used to check for abnormalities within the parotid gland.
Treatment Options for Eyelid Myokymia
If you have isolated eyelid myokymia, which is a condition where your eyelid twitches uncontrollably, the recommended approach is usually to change some of your lifestyle habits. This can include getting more rest and reducing or removing things like alcohol, smoking, and caffeine from your routine. These can all help to control the twitching of your eyelid.
If your eyelid continues to twitch for more than three months, further action may be required. Injections of a substance called botulinum toxin are commonly used and are generally successful for treating this condition.
Additionally, there have been some suggestions for other treatments such as drinking tonic water or taking supplements like calcium, folic acid, phosphorus, potassium, and multi-vitamins. However, there’s not much solid evidence to back up these treatments.
Rarely, an operation called orbicularis myectomy might be considered. But this is more of a last resort and is hardly ever used.
What else can Eyelid Myokymia be?
Myokymia is a condition where the eyelid experiences spontaneous, gentle, and continuous shaking. However, there are other conditions that might be confused with myokymia because they show similar symptoms. These include:
- Hemifacial spasm
- Essential blepharospasm
- Meige syndrome
- Spastic-paretic facial contracture
What to expect with Eyelid Myokymia
Having isolated eyelid myokymia, a condition that causes twitching or spasm in the muscles of your eyelid, generally has positive outcomes. It’s a harmless condition that is not expected to turn into other facial movement disorders or be connected to other neurological diseases.
Most affected patients see their symptoms gradually improve over a couple of months. While doctors often suggest reducing stress and anxiety as potential relief, the scientific evidence to back this up is rather scarce. Interestingly, most patients seem to fully recover after just one injection of a substance called botulinum neurotoxin (a muscle relaxant).
However, it’s not fully clear whether this positive outcome is directly down to this chosen treatment, or simply due to the natural course of the condition itself.
Possible Complications When Diagnosed with Eyelid Myokymia
While eyelid myokymia, or involuntary twitching of the eyelid, is not a dangerous condition, it can be an early sign of other more serious conditions that can impact the muscles of the face. These can occur on one or both sides:
- Hemifacial spasm – This condition creates involuntary muscle contractions on one side of the face.
- Essential blepharospasm – This condition results in abnormal, involuntary blinking or spasm of the eyelids.
- Meige syndrome – This condition causes involuntary and frequently forceful contractions of the jaw and eye muscles.
- Spastic-paretic facial contracture – This condition includes spasms and weakness in the facial muscles.
Preventing Eyelid Myokymia
Myokymia, also known as eyelid twitching, usually clears up on its own. Typically, with some rest and by avoiding things that may trigger it, the twitching stops within a few days or weeks. However, sometimes you may need to see a specialist. Situations that call for a specialist’s help include:
* If your eye continues to twitch for more than a few weeks.
* If the twitching starts affecting other parts of your face.
* If you find it difficult to open your eye.
* If your eyelid completely closes with each twitch, which could be sign of a more serious condition called a hemifacial spasm.
* If there is redness or swelling in your eyelid.
* If your eyelid begins to droop.
