Eyelid Myokymia Clinical Presentation

Updated: Jan 03, 2022
  • Author: Byron L Lam, MD; Chief Editor: Edsel B Ing, MD, PhD, MBA, MEd, MPH, MA, FRCSC  more...
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Presentation

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, clozepine, flunarizine, or gold salts has been uncommonly associated with eyelid myokymia. [2]

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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, spastic-paretic facial contracture, multiple sclerosis, autoimmune disease, and brainstem lesions (eg, pontine glioma) 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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