Persistent Left Eyelid Twitching: Causes, Concerns, and Next Steps

Q: Persistent Left Eyelid Twitching: Causes, Concerns, and Next Steps

Hello Mr. <br>Lin： The subjective twitching of the eyelid is generally not considered to require treatment in ophthalmology, unless it is accompanied by severe spasms that make it difficult to open the eyes or simultaneous facial twitching. <br>If these two phenomena are present,

The left eyelid has been twitching intermittently for nearly a year?

Hello, my left eyelid has been twitching constantly for nearly a year.
It feels like there is something inside my eyeball that is expanding and contracting rhythmically, which is very uncomfortable.
I have not been able to pinpoint the exact location of the twitching on my eyelid (initially thought it was just a simple eyelid spasm, but it is not).
I have visited two ophthalmology clinics (a hospital and a private clinic), and both diagnosed me with dry eye syndrome, prescribing some artificial tears for lubrication, which have been completely ineffective.
Additionally, I consulted a neurologist, and after electrolyte tests showed no abnormalities, the doctor suggested it might be due to degeneration of the peripheral nerves in the eye and prescribed Rivotril 0.5mg tablets, which also did not yield any results.
The twitching has persisted.
The doctor checked for double vision and does not suspect a tumor.
Due to the continuous twitching, my eyes feel very fatigued and somewhat painful, and I have excessive tear production.
My vision also seems a bit blurry (not sure if it's due to worsening presbyopia, but I can feel that the elasticity of my eyeball is deteriorating, making it difficult to focus).
I am very concerned about other potential diseases.
I have a history of heart catheterization with stent placement and hypertension, for which I am currently on medication.
Is it possible that my medications are causing this? (Crestor 10mg, TritACE 2.5mg, Famotidine F.C.
20mg, Bokey 100mg, Concor 1.25mg).
Could you please provide me with some guidance on where to seek further medical attention? Should I continue with ophthalmology or see a neurologist? Are there more advanced diagnostic tools available, such as a CT scan?

Mr. Lin, 50~59 year old female. Ask Date: 2024/04/12

Dr. He Jianxian reply Ophthalmology

Hello Mr.
Lin: The subjective twitching of the eyelid is generally not considered to require treatment in ophthalmology, unless it is accompanied by severe spasms that make it difficult to open the eyes or simultaneous facial twitching.
If these two phenomena are present, it is necessary to differentiate whether it is due to arterial compression of the facial nerve or abnormal discharges of the facial nerve.
Based on your description, it appears to be a subjective condition, which does not require treatment in a clinical setting.
Director He Jianxian, Department of Ophthalmology, Nantou Hospital.

Reply Date: 2024/04/12

More Info

Persistent eyelid twitching, also known as myokymia, can be a frustrating and uncomfortable condition. Your experience of having left eyelid twitching for nearly a year, accompanied by sensations of pressure and discomfort, is certainly concerning. Given your medical history, including heart issues and high blood pressure, it’s understandable that you are worried about potential underlying causes.

Possible Causes of Eyelid Twitching
1. Fatigue and Stress: One of the most common causes of eyelid twitching is fatigue, stress, or anxiety. These factors can lead to muscle spasms, including those in the eyelids. Given the chronic nature of your symptoms, it’s essential to evaluate your lifestyle and stress levels.

2. Dry Eyes: Although you mentioned that artificial tears did not help, dry eyes can still be a contributing factor. Chronic dryness can lead to irritation and twitching. It may be worth exploring other treatments for dry eyes, such as punctal plugs or prescription medications.

3. Caffeine and Stimulants: Excessive intake of caffeine or other stimulants can lead to muscle spasms. Consider reducing your caffeine consumption to see if it alleviates your symptoms.

4. Neurological Issues: While your neurologist has ruled out tumors and other severe conditions, persistent twitching can sometimes be associated with neurological disorders, such as blepharospasm or hemifacial spasm. These conditions may require further evaluation by a neurologist specializing in movement disorders.

5. Medication Side Effects: Some medications can cause muscle spasms or twitching as a side effect. While the medications you listed are generally well-tolerated, it’s worth discussing with your doctor whether any of them could be contributing to your symptoms.

6. Nutritional Deficiencies: Deficiencies in certain vitamins and minerals, particularly magnesium, can lead to muscle spasms. A blood test can help determine if you have any deficiencies.

Next Steps for Evaluation
1. Consult an Eye Specialist: Since you have already seen two eye doctors, consider seeking a third opinion, preferably from a specialist in ocular neurology. They may perform more specialized tests to assess the function of your eyelid muscles and the overall health of your eyes.

2. Neurological Evaluation: If you haven’t already, consider a follow-up with your neurologist. They may recommend imaging studies, such as an MRI or CT scan, to rule out any neurological conditions that could be causing your symptoms.

3. Electromyography (EMG): This test can assess the electrical activity of your muscles and may help identify any neuromuscular issues contributing to your eyelid twitching.

4. Lifestyle Modifications: In addition to medical evaluations, consider implementing stress-reduction techniques such as mindfulness, yoga, or regular exercise. Ensuring adequate sleep and hydration can also be beneficial.

5. Nutritional Assessment: A consultation with a nutritionist may help identify any dietary deficiencies that could be contributing to your symptoms.

Conclusion
Persistent eyelid twitching can be multifactorial, and while it may not indicate a severe underlying condition, it is essential to continue seeking answers. Given your medical history and the chronic nature of your symptoms, a comprehensive approach involving both eye care and neurological evaluation is warranted. Keep a detailed log of your symptoms, lifestyle factors, and any changes you notice, as this information can be invaluable for your healthcare providers in diagnosing and managing your condition effectively.

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