Eyelid Myokymia Treatment & Management

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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Treatment

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.

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Diet

Excessive caffeine and possibly alcohol intake may be associated with eyelid myokymia.

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Activity

Excessive physical exertion may be associated with eyelid myokymia.

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Prevention

If precipitating factors can be identified, avoidance can reduce the frequency of episodes.

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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.

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