Twitching Eyelid (Myokymia)

Change Language German

Clinical Presentation

  • Fine, isolated rhythmic twitching of the upper/lower eyelid
    • Mostly unilateral and on the lower lid
    • Periodic, lasting seconds to hours (sometimes chronic)


  • Stress
  • Lack of sleep
  • Caffeine
  • Dry eye
  • Vitamin B deficiency, magnesium deficiency
  • Alcohol, nicotine
  • Thyroid disease
  • Rarely medication-related (e.g., topiramate, clozapine, flunarizine)


  • Detailed medical history
  • Slit lamp examination (sometimes difficult to see)
  • Pulling on the affected lid often improves twitching
  • Tapping on the affected area can sometimes reveal twitching
  • Imaging usually not necessary


  • Usually self-limiting, good prognosis
  • Avoid triggers (see Causes)
  • Treat dry eye
  • Alternatively, for chronic forms (>3 months), botulinum toxin injections (5-20 units)
  • Other treatment options (not evidence-based) include: tonic water, calcium, folic acid, phosphate, potassium, multivitamin supplements

Differential Diagnoses

  • Hemifacial spasm
  • Essential blepharospasm
  • Meige syndrome

Red Flags

  • No improvement within a few weeks
  • Twitching in other facial areas
  • Difficulty opening the eye
  • Complete eyelid closure with each fasciculation
  • Redness/swelling
  • Ptosis of the upper eyelid


  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Kalla Gervasio MD, Travis Peck MD et al; Lippincott Williams&Wilkins; 8th Edition (2021)
  • Jafer Chardoub AA, Patel BC. Eyelid Myokymia. [Updated 2021 Nov 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: