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Eyelid Myokymia Clinical Presentation

  • Author: Byron L Lam, MD; Chief Editor: Edsel Ing, MD, FRCSC  more...
 
Updated: May 17, 2016
 

History

Patients with eyelid myokymia usually note sporadic "jumping" or "twitching" of one of the lower eyelids. Eyelid myokymia may also involve one of the upper eyelids or multiple eyelids. The irregular contractions are usually unilateral and may occur intermittently for days to months.

In rare cases, the contractions may be severe enough to move the eye to produce oscillopsia.

A history of stress, fatigue, and excessive caffeine or alcohol intake may be present. The use of topiramate in migraineurs has been questioned as a cause of eyelid myokymia.[1]

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Physical

Fine fascicular nonsynchronous contractions of the orbicularis oculi may be visible if the patient has the contractions during examination. If present, the contractions are usually intermittent and are more apparently felt by the patient than visible to the observer. The symptoms often improve when the eyelid is pulled manually. Rarely, the contractions may be vigorous enough to cause movement of the globe, producing fine nystagmuslike eye movements.

If the eyelid myokymia is associated with contraction of other parts of the face, hemifacial spasm, blepharospasm, Meige syndrome, and spastic-paretic facial contracture should be excluded. Activation of the facial muscles (eg, big smile, eyelids squeezed shut) helps to determine if the eyelid myokymia is associated with contractions of other parts of the face.

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Causes

The cause is unknown but may be associated with stress, fatigue, and excessive caffeine or alcohol intake.

Demyelination and brainstem lesions are rarely found in patients thought to have eyelid myokymia.

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Contributor Information and Disclosures
Author

Byron L Lam, MD Professor, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine

Byron L Lam, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Hospital for Sick Children and Sunnybrook Hospital

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, Canadian Society of Oculoplastic Surgery, European Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Ontario Medical Association, Statistical Society of Canada, Chinese Canadian Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Ron W Pelton, MD, PhD Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, AO Foundation, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society

Disclosure: Nothing to disclose.

References
  1. Medrano-Martínez V, Pérez-Sempere A, Moltó-Jordá JM, Fernández-Izquierdo S, Francés-Pont I, Mallada-Frechin J, et al. Eyelid myokymia in patients with migraine taking topiramate. Acta Neurol Scand. 2015 Aug. 132 (2):143-6. [Medline].

  2. Baldwin MR, Barbieri JT. Association of Botulinum neurotoxins with synaptic vesicle protein complexes. Toxicon. 2009 Apr 8. [Medline].

  3. Brin MF. Basic and clinical aspects of BOTOX((R)). Toxicon. 2009 Mar 31. [Medline].

  4. Pickett A. Dysport((R)): Pharmacological properties and factors that influence toxin action. Toxicon. 2009 Mar 28. [Medline].

  5. Moe ST, Thompson AB, Smith GM, Fredenburg RA, Stein RL, Jacobson AR. Botulinum neurotoxin serotype A inhibitors: small-molecule mercaptoacetamide analogs. Bioorg Med Chem. 2009 Apr 15. 17(8):3072-9. [Medline].

  6. Capkova K, Salzameda NT, Janda KD. Investigations into small molecule non-peptidic inhibitors of the botulinum neurotoxins. Toxicon. 2009 Mar 25. [Medline].

  7. Andermann F, et al. Facial myokymia in multiple sclerosis. Brain. 1961. 8:31-44.

  8. Banik R, Miller NR. Chronic myokymia limited to the eyelid is a benign condition. J Neuroophthalmol. 2004 Dec. 24(4):290-2. [Medline].

  9. Givner I, Jaffe NS. Myokymia of the eyelids; a suggestion as to therapy; preliminary report. Am J Ophthalmol. 1949 Jan. 32(1):51-5. [Medline].

  10. Krohel GB, Rosenberg PN. Oscillopsia associated with eyelid myokymia. Am J Ophthalmol. 1986 Nov 15. 102(5):662-3. [Medline].

  11. Lowe R. Facial Twitching. Trans Ophthalmol Soc Aust. 1951. 11:129-133.

  12. Reinecke RD. Translated myokymia of the lower eyelid causing uniocular vertical pseudonystagmus. Am J Ophthalmol. 1973 Jan. 75(1):150-1. [Medline].

  13. Rubin M, Root JD. Electrophysiologic investigation of benign eyelid twitching. Electromyogr Clin Neurophysiol. 1991 Sep. 31(6):377-81. [Medline].

  14. Scott AB. Botulinum toxin for blepharospasm. Spaeth G, Katz LJ, Parker KW, eds. Current Therapy in Ophthalmic Surgery. Toronto: Decker; 1989. 322-324.

  15. Sogg RL, Hoyt WF, Boldrey E. Spastic paretic facial contracture. A rare sign of brain stem tumor. Neurology. 1963 Jul. 13:607-12. [Medline].

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