You Asked: Why does my eyelid twitch at random times?

You are up late eyeballing a term paper, and suddenly, part of one eyelid starts twitching. Virtually everyone has experienced that jittering sensation around the eye, and in annoyance, we often wonder, “Why is this happening?”

Single eyelid twitches are called myokymia, which are uncontrolled muscle contractions of the eyelid. Random, involuntary spasms, ordinarily felt in the lower eyelid and sometimes in the upper eyelid, are normal and often subside within minutes.

“There is typically no reason to be concerned about these slight tremors, which are common,” said Robert H. Rosa Jr., MD, professor of surgery and medical physiology at the Texas A&M College of Medicine. “However, they could be a cause for concern if the twitching persists intermittently for more than a few weeks.”

Although it may be impossible to pinpoint a single cause of an eyelid twitch, Rosa said they may be provoked by fatigue from lack of sleep, straining of the eyelids for too long or physical exertion. Stress, side effects of medication and consuming alcohol, tobacco or caffeine may also be a trigger of spasms. “Stimulants, like caffeine, can escalate activity in the nerves and muscles,” Rosa said. “Caffeine blocks neurotransmitters, like adenosine, that make us tired and cue the release of excitatory neurotransmitters, like serotonin and noradrenaline, that stimulate activity.” Neurotransmitters are brain chemicals that transmit messages between neurons, or nerve cells.

Stress and lack of sleep have also been tied to muscle spasms in general. “The cause isn’t definitively known, but when stressed, the body produces epinephrine, or adrenaline,” Rosa said. “This fight-or-flight reaction stimulates muscle function to prepare the body for quick action.” Prolonged muscle activity could lead to small, sporadic contractions of muscle tissue throughout the body and perhaps in the eyelid.

The twitches may also be exacerbated by any number of other reasons: inflammation of the eyelid known as blepharitis; sensitivity to irritants such as light, wind or pollution; excessive alcohol, caffeine or tobacco use; dry eyes; conjunctivitis, which is commonly called pinkeye; or corneal scratches. If you think your eye is infected or injured, you should contact your health care provider.

“On rare occasions, twitching of the eyelid may manifest itself into a more chronic condition known as benign essential blepharospasm,” Rosa said. As the use of the term “benign” implies, the condition is not life threatening, but again, the cause is unknown. Benign essential blepharospasm is a form of dystonia, which is a neurological movement disorder characterized by uncontrolled, extended and frequent muscle contractions. “Its symptoms could progress, potentially leading to blurred vision, elevated light sensitivity or tremors extending to other areas of the face,” Rosa said.

Hemifacial spasms are another type of dystonia that occurs when the facial nerve, stemming from the foreside of the ear, becomes compressed by a blood vessel in the skull and causes the muscles on one side of the face to contract. These contractions tend to initially present themselves in the orbicularis oculi, which is the muscle that closes the eyelid.

If accompanied by other symptoms, these extremely rare reactions could be indicative of a more serious brain or nerve disorder, and a health care provider should be contacted immediately to treat the underlying condition. Such chronic eye twitching may be symptomatic of neurological diseases including multiple sclerosis, Parkinson’s disease, Bell’s palsy and Tourette’s syndrome, among others. Still, people experiencing only the occasional twitch should not panic; these conditions remain quite rare.

For those bothered by it, twitching can be helped with simple lifestyle modifications. “Treatment of general, non-chronic eye twitching is quite simple,” Rosa said. “For most people, increasing sleep, reducing stress, and limiting caffeine, alcohol and tobacco should help the twitching subside.” Applying a warm compress to the area may relax the eye muscles and minimize spasms, and over-the-counter eye drops will lubricate the membranes of the eye to reduce dryness.

Those who experience benign essential blepharospasms or hemifacial spasms can usually be relieved of the annoying twitching by being administered botulinum toxin, or Botox, which paralyzes the muscle for a few months. However, the effects are only temporary, and patients require further injections. A more permanent solution for severe cases involves surgically removing some of the muscles and nerves in the eyelids or decompressing the vascular pressure on the affected nerve. A number of therapies such as physical, massage, nutritional and acupuncture are among a number of methods to aid in muscle relaxation that could prove beneficial for alleviating contractions.

“Overall, eye twitches are not generally a reason to fret,” Rosa said. “Monitor the frequency and severity of the spasms, and should you begin to have growing concerns about their persistence, contact your health care provider. Commonly, we expect twitches to be over in the blink of an eye.”