Eyelid Twitching: When to Seek Neurological Evaluation

Eyelid twitching?

Hello doctor, my left lower eyelid has been twitching for over a month.
I consulted an ophthalmologist who confirmed that my eyes are normal and there are no issues.
The twitching frequency varies, and it doesn't cause my entire eye to close, nor do other areas twitch along with it.
However, I am still concerned that it might be caused by other neurological issues.
Recently, for the past week, my right lower eyelid has been twitching slightly.
Should I undergo a thorough brain examination?

Jill, 30~39 year old female. Ask Date: 2021/10/06

Dr. Jiang Junyi reply Neurology

Dear Miss Jill,
You mentioned "twitching of the lower left eyelid." Generally, eyelid movements are controlled by the facial nerve.
If the eyelid is twitching continuously, the physician will first carefully observe the patient's face.
If, aside from the eyelid, no other facial muscles are twitching, it is likely a simple eyelid twitch.
However, if other muscles are also experiencing spasms, it may indicate facial nerve spasms.

Certain situations in daily life can trigger this issue, such as exercise, acute viral infections, anxiety, and medication use.
Prolonged exercise is one of the primary causes of muscle twitching.
Additionally, some medications may exacerbate tremors, including diuretics, corticosteroids, estrogens, and excessive caffeine intake.
Muscle relaxants can be used for treatment, and in more severe cases, botulinum toxin injections may be administered.

Clinically, if symptoms progress and are accompanied by other neurological abnormalities, brain imaging studies will be arranged.
I recommend that you consult a neurologist for discussion and treatment.
Thank you for your inquiry, and feel free to reach out with any related questions!
Wishing you good health and peace,
Dr.
Cheng-Jun Yi, Taoyuan Medical Center

Reply Date: 2021/10/06

More Info

Eyelid twitching, also known as myokymia, is a common condition that can cause concern, especially when it persists for an extended period. In your case, the left lower eyelid has been twitching for over a month, and now the right lower eyelid has also started to twitch. It’s understandable to worry about potential neurological issues, especially since you have already consulted an ophthalmologist who found no problems with your eyes.

Eyelid twitching can be caused by various factors, including stress, fatigue, caffeine intake, and eye strain. In many instances, these benign causes can lead to temporary twitching that resolves on its own. However, when twitching persists for weeks or months, it may warrant further investigation, particularly if it is accompanied by other symptoms such as changes in vision, facial spasms, or weakness.

In your situation, since an eye specialist has already evaluated your eyes and found them to be normal, it may be beneficial to consider the following:
1. Stress and Fatigue: High levels of stress and lack of sleep can contribute to eyelid twitching. If you have been experiencing increased stress or changes in your sleep patterns, addressing these factors may help alleviate the twitching.

2. Caffeine and Stimulants: Excessive consumption of caffeine or other stimulants can lead to muscle spasms, including eyelid twitching. Reducing your intake of coffee, tea, energy drinks, and other sources of caffeine might be beneficial.

3. Eye Strain: Prolonged screen time or reading without breaks can lead to eye strain, which may trigger twitching. Ensure you are taking regular breaks and practicing the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds.

4. Neurological Evaluation: If the twitching continues or worsens, or if you develop additional symptoms such as facial twitching, weakness, or changes in sensation, it would be prudent to seek a neurological evaluation. A neurologist can perform a thorough assessment, which may include imaging studies such as an MRI or CT scan if deemed necessary.

5. Other Conditions: In rare cases, persistent eyelid twitching can be associated with conditions such as blepharospasm or hemifacial spasm, which may require specialized treatment. If you notice any changes in the pattern of twitching, such as it becoming more frequent or affecting other areas of your face, this should be discussed with a healthcare professional.

In summary, while eyelid twitching is often benign and self-limiting, persistent symptoms warrant further evaluation, especially if they are accompanied by other neurological signs. It is always better to err on the side of caution and consult a neurologist if you have concerns about underlying neurological issues. They can provide a comprehensive evaluation and determine if any further testing or treatment is necessary.

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