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A-Z Glossary

Table of Contents

Myokymia

Courtney Dryer, OD
Written byCourtney Dryer, OD
Courtney Dryer, OD
Courtney Dryer, ODOptometristCharlotte, NC

Bio

Dr. Courtney Dryer earned her doctorate from Southern College of Optometry, Memphis, Tennessee in 2011. She opened her own practice Autarchic Spec Shop in 2013 in Charlotte, NC. She has had the privilege of writing for numerous optometric publications and serving in various industry capacities. In 2015, Vision Monday named her a rising star and one of the most influential women in optometry. Her optometric passions include practice management, specialty contact lenses, and dry eye management.

  • Last updated March 21, 2023

What is Myokymia?

Ocular myokymia is a series of spontaneous, gentle, constant, rippling contractions that spread through the affected striated muscle. Eyelid myokymia is the most common type of facial myokymia with the orbicularis oculi being the most affected muscle. Chronic, isolated eyelid myokymia is a benign condition and is not associated with any other neurologic disease. Eyelid myokymia can spread to additional muscles on one or both sides of the face referred to as facial myokymia.

Key Takeaways

  • Ocular myokymia is a contraction of the orbicularis oculi.
  • Stress, caffeine, and fatigue are thought to be factors.
  • No treatment is needed, contractions are self-limited.
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Understanding Myokymia

Myokymia is likely to be unilateral and affects the lower eyelid more frequently than the upper eyelid. The contractions are self-limited, periodic, and last seconds to hours. In rare cases, upper and lower eyelids involvement can occur on the same side and at the same time.

Factors that Cause Myokymia

The exact cause of ocular myokymia is unknown, but there are some associated factors including stress, fatigue, and caffeine intake. Female gender and cold weather are risk factors for chronic eyelid myokymia. It tends to affect healthy young subjects. Medication-induced myokymia is uncommon, but medications like topiramate, clozapine, gold salts, and flunarizine can trigger eyelid myokymia. 

Facial myokymia can be caused by damage to the facial nerve nucleus in the pons of the brain from demyelinating diseases, such as multiple sclerosis or compression from brainstem tumors. Rarely, persistent eyelid myokymia has been reported as a presenting sign of multiple sclerosis or a brainstem tumor.

Superior oblique myokymia is an uncommon condition often misdiagnosed. Presentation includes double vision and a “jumping image.” It typically affects one eye of young adults. There is no known cause, but may also be associated with multiple sclerosis, trauma or tumor involving the pons. 

Myokymia Symptoms

  • Twitching of the upper or lower eyelid
  • Twitching of the face

Diagnosing Myokymia

Fine contractions of the orbicularis oculi muscle may be noticeable during an eye exam. Routine neuroimaging studies for patients with chronic myokymia are unnecessary because of their low yield findings. Facial myokymia may need neuroimaging if the cause is unknown.

Myokymia Treatment

There is no way to stop or “fix”  short-term myokymia. Conservative management includes rest, reassurance, and decreased caffeine consumption. 

In the case of myokymia persisting for more than three months, botulinum toxin injections are successful as first-line treatment.

If the cause of facial myokymia is multiple sclerosis, it often improves on its own after days or weeks. If due to a brain tumor, it may persist. Both of these conditions require multidisciplinary care.

Bibliography

  1. Banik R, Miller NR. Chronic myokymia limited to the eyelid is a benign condition. J Neuroophthalmol. 2004 Dec;24(4):290-2. doi: 10.1097/00041327-200412000-00003. PMID: 15662242.
  2. Jafer Chardoub AA, Patel BC. Eyelid Myokymia. 2022 May 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 32809430.
  3. Miller NR. Eyelid myokymia. Surv Ophthalmol. 2011 May-Jun;56(3):277-8; author reply 278. doi: 10.1016/j.survophthal.2011.02.005. PMID: 21501741.
  4. Moshirfar M, Somani SN, Shmunes KM, Ronquillo YC. Will Tonic Water Stop My Eyelid Twitching? Clin Ophthalmol. 2020 Mar 4;14:689-691. doi: 10.2147/OPTH.S235895. PMID: 32184555; PMCID: PMC7061523.
  5. Patel BC, Malhotra R. Superior Oblique Myokymia. [Updated 2022 May 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

 

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