Practice Essentials

Eyelid myokymia is typically benign, self-limited, and not associated with any disease. Intervention is usually unnecessary. Botulinum toxin injections are the treatment of choice when needed. Rarely, eyelid myokymia may occur as a precursor of hemifacial spasm, blepharospasm, Meige syndrome, spastic-paretic facial contracture, multiple sclerosis, autoimmune disease, and brainstem lesions (eg, pontine glioma). MRI with contrast to image the central and peripheral pathways of the facial nerve is warranted in rare cases. Medication related eyelid myokymia rarely occurs with agents such as topiromate, clozepine, flunarizine, and gold salts.^[1]

Background

Myokymia is characterized by spontaneous, fine fascicular contractions of muscle without muscular atrophy or weakness. Eyelid myokymia results from fascicular contractions of the orbicularis oculi muscle. Eyelid myokymia is typically unilateral, with the most common involvement being one of the lower eyelids. When multiple eyelids are involved, the fascicular contractions of each eyelid are independent of each other. The contractions are periodic and last seconds to hours.

In most cases, eyelid myokymia is benign, self-limited, and not associated with any disease. Intervention is usually unnecessary. Rarely, eyelid myokymia may occur as a precursor of hemifacial spasm, blepharospasm, Meige syndrome, spastic-paretic facial contracture, multiple sclerosis. autoimmune disease, and brainstem lesions (eg, pontine glioma). Medication related eyelid myokymia rarely occurs with agents such as topiromate, clozepine, flunarizine, and gold salts.

Pathophysiology

Consisting of involuntary fine undulating contractions across the striated muscle, the pathophysiology of eyelid myokymia is not well understood. The contractions are nonsynchronous semirhythmic discharges of motor units discharging at a rate of 3-8 Hz. The discharges have intervals of 100-200 ms between individual motor bursts. The contractions are transient and intermittent. 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 suggested. 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 frequently encountered in the ophthalmic clinic.

Mortality/Morbidity

Eyelid myokymia is a benign and self-limited condition in most patients, but, in some cases, it may be a precursor of hemifacial spasm, blepharospasm, Meige syndrome, spastic-paretic facial contracture, facial myokymia, multiple sclerosis. autoimmune disease, and brainstem lesions (eg, pontine glioma). Medication related eyelid myokymia rarely occurs with agents such as topiromate, clozepine, flunarizine, and gold salts.