What Is Myokymia And When Does Treatment Become Necessary?

Diagnosing and treating neurological and neuromuscular conditions relies on expert examination of symptoms that can sometimes be overlooked, and one of the most common examples of this is found with cases of myokymia which require treatment.

Almost everyone will experience facial myokymia at some point in their lives, and the wave-like twitches in the eyelid will often emerge and dissipate seemingly without any reason or consequence outside of mild frustration.

However, there are rare cases where a myokymia does not go away or is a potential sign of a neuromuscular condition that requires specialist treatment to manage.

To understand why, it is important to know under which circumstances a specialist may need to intervene.

If The Twitch Lingers

A myokymia is a fairly common twitch most commonly experienced in the eyelids, which can last just a few seconds or persist mildly for a few hours. They generally feel like waves or gentle tugs on the eyelids and do not last long enough to be disruptive.

However, if a twitch is felt persistently for longer than a week or two weeks, it could be caused by a condition that may require some form of management or treatment.

If All Common Causes Can Be Ruled Out

Whilst eyelid myokymia can occur for a wide variety of reasons, the most common causes include tiredness, fatigue, stress, anxiety, alcohol and caffeine, as well as the side effects of some prescription medications. It can sometimes be the result of exercise due to the irritating effect of sweat.

They can also be caused by eye irritation, exposure to tobacco, light sensitivity, dry eyes or as a side effect of migraine episodes.

Some of these causes can be managed, and if an episode of myokymia settles as a result of changes to lifestyle habits, then treatment is unlikely to be necessary.

However, if the twitching persists and other factors do not explain its severity or frequency, it may need to be examined further.

If The Twitch Is Disruptive

In most cases, whilst myokymia can occasionally be annoying, it is in most cases harmless, and once the twitching goes away, it will not cause any further frustration.

However, there are cases where the twitching is persistent and intense enough to cause frequent disruptions to eyesight and focus, it is important to see a specialist to see if treatment is required.

Disruption is subjective, but it is often better to take a cautious approach, particularly if there have not been any major changes that would cause typical twitches to become more frequent. Even if it is not a sign of a serious condition, it is important to be certain.

Specialists will typically diagnose myokymia with a number of simple tests, but they can also either determine a root cause or recommend more conclusive tests such as an MRI or CT scan.

If The Eyelid Completely Closes

Related to this disruption, some types of myokymia cause the eyelid to close completely whenever there is a twitch, which can be a sign of a neurological or neuromuscular condition that would require treatment.

Similarly, if the upper eyelid droops, it could be a sign of a potentially serious eye condition and should be investigated. It can be a symptom of benign essential blepharospasm, a form of dystonia where eyelids involuntarily close.

Blepharospasm is typically treated using injections, medication or radiosurgery, depending on its severity and the frequency of twitching episodes.

If The Twitch Spreads From The Eyelid

Eyelid twitches are sometimes an early symptom of hemifacial spasm, a condition where either individual or groups of muscles on one side of the face involuntarily contract.

A hemifacial spasm typically progresses to include several muscles and requires treatment either in the form of botox injections, anti-epileptic medications, surgery or radiosurgery in order to remove the potential causes of the issue.

Several facial conditions begin from the eyelid before spreading, so a specialist will attempt to rule out as many other causes as possible.

If There Are Other Symptoms

In some cases, myokymia is not the only symptom that is noticed and observed, and typically a twitch in conjunction with another related or semi-related symptom could be the sign of a more serious condition.

Outside of the symptoms above, if the twitching happens after a head or eye injury, it could be a serious side effect of said injury that could cause permanent damage if not treated.

Similarly, if the eye is swollen, red with irritation or there is some kind of pus or discharge emanating from it, it could be a symptom of a serious infection that should also be treated.

While myokymia is usually harmless and self-resolving, symptoms that persist, spread, or interfere with daily life should be evaluated by a neurologist. At Queen Square, our specialists provide expert assessment and tailored care for a wide range of facial and neuromuscular conditions.

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