Sometimes we notice our eyelids twitching and chalk it to tiredness. But when we see our lids moving while looking in the mirror, we worry.

Most of these eyelid spasms are benign episodes, and not worrisome. But there are twitchings that may be associated with other problems and require further assessment.

An eyelid twitch or tic is a quick quivering of the lids that may occur once or several times during the day. This does not affect the vision and the twitching will not be strong enough to close the eye.

Usually, these episodes are caused by lack of sleep. Caffeine can also cause these movements and dry tired eyes. People rushing to finish a project way into the night, drinking many cups of coffee and staring at their computer screens at length are the usual complainers. A good night’s sleep, drinking decaf and following the 20-20-20 rule (see https://www.advocatesomi.com/lockdown-eye-woes 24 May 2020) can help address the tic. Lubricant eyedrops can also greatly improve dry eyes and lessen the twitching. However, if the twitching persists and lasts longer than usual, or if it bothers your vision, read further.

Some twitching can be so severe that the eye closes. Sometimes the episodes are prolonged or occur more frequently that activities of daily living are affected. Patients complain that they can’t drive because the constant eye closure puts them at risk for vehicular accidents. Others say even walking becomes difficult because they miss steps and become prone to tripping.

At the eye doctor’s clinic, a test is done to check cranial nerves. If only the eyelids are affected, this is called an Essential Blepharospasm. There is a problem with the nerve impulses sent to the muscles (the orbicularis oculi) causing the muscle to keep moving. It is still unclear how this happens though. Depending on the severity of the symptoms, some doctors may start a patient on a trial of B vitamins. It can improve the symptoms a bit but will not completely cure it.

For more debilitating spasms, Botulinum toxin is injected to the muscle every three to six months, relieving the movements. However, the effect only lasts three months. Sometimes for very severe symptoms not improved with the injections, surgery to remove some of the muscle may be warranted.

If during the first check up the doctor also notes that half of the face moves with the eyelid, this is called a Hemifacial Spasm. The facial nerve is affected. Your doctor may recommend further diagnostic testing to check if there are other nerves affected or if there is a tumor pressing on the nerve. If it turns out to be the only problem, the same treatment is offered as in Essential Blepharospasm- botulinum toxin injections to the affected muscles of the lids and face.

Did you tick (tic? hehe) any of these? If you’re unsure, consult your eye doctor today.