eMedicine Specialties > Ophthalmology > Lid

Eyelid Myokymia

Author: Byron L Lam, MD, Professor, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine
Contributor Information and Disclosures

Updated: Apr 14, 2009

Introduction

Background

Myokymia is the spontaneous, fine fascicular contractions of muscle without muscular atrophy or weakness. Eyelid myokymia typically involves the orbicularis oculi muscle of one of the lower eyelids; occasionally, one of the upper eyelids can be affected. In most cases, eyelid myokymia is benign, self-limited, and not associated with any disease. Intervention is usually necessary. Rarely, eyelid myokymia may occur as a precursor of hemifacial spasm, blepharospasm, Meige syndrome, and spastic-paretic facial contracture.

Pathophysiology

The pathophysiology of typical eyelid myokymia is not well understood. The focus of irritation is most likely the nerve fibers within the muscle. Pontine dysfunction in the region of the facial nerve nucleus also has been implicated. Possible precipitating factors include stress, fatigue, and excessive caffeine or alcohol intake.

Frequency

United States

The incidence and prevalence of eyelid myokymia are unknown, but symptoms of eyelid myokymia are not infrequently encountered in the ophthalmic clinic.

Mortality/Morbidity

Eyelid myokymia is a benign and self-limited condition in most patients.

Age

Eyelid myokymia may occur at any age.

Clinical

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. 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.

Physical

  • Fine 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 apparent to the patient than 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.

Causes

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

More on Eyelid Myokymia

Overview: Eyelid Myokymia
Differential Diagnoses & Workup: Eyelid Myokymia
Treatment & Medication: Eyelid Myokymia
Follow-up: Eyelid Myokymia
References
Further Reading
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References

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

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

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

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

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

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

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

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

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

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

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

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

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

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Keywords

eyelid myokymia, eyelid twitching, eyelid jumping, muscle contractions, blepharospasm, Meige syndrome, hemifacial spasm, spastic-paretic facial contracture, botulinum toxin A, BOTOX®, BOTOX® injections

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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, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

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 Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society, Utah Medical Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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