Medical Care
Reassurance and reduction in precipitating factors, if identifiable, are appropriate for many patients.
When symptoms are severe, local subcutaneous botulinum toxin A (BOTOX®) injections of 2.5-5 units each to the affected eyelid region provide relief for 12-18 weeks. If the upper eyelid is involved, the injections should not be placed near the levator palpebrae; otherwise, ptosis lasting weeks will result. [3, 4, 5, 6, 7]
Adverse effects include temporary lid laxity, which may produce lagophthalmus, exposure keratopathy, ptosis, and diplopia.
The efficacy of other agents has not been proven.
Diet
Excessive caffeine and possibly alcohol intake may be associated with eyelid myokymia.
Activity
Excessive physical exertion may be associated with eyelid myokymia.
Prevention
If precipitating factors can be identified, avoidance can reduce the frequency of episodes.
Long-Term Monitoring
Rarely, eyelid myokymia may occur as a precursor of blepharospasm, Meige syndrome, hemifacial spasm, facial myokymia, spastic-paretic facial contracture, multiple sclerosis, autoimmune disease, and brainstem lesions (eg, pontine glioma).
Advise patients to return for reexamination, if there is a change in symptoms.
