Upper Eyelid Twitching : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 07/09/2022

Twitching of the upper eyelid often occurs in healthy people, it becomes the result of stress, physical or intellectual overwork, and other negative factors. It can be observed in idiopathic blepharospasm, paresis of the facial nerve, brain tumor, ALS, some other neurological diseases, allergic conjunctivitis, neuroses in adults and children. The cause of the symptom is established according to the conversation, neurological examination, additional studies. Treatment - glucocorticoids, muscle relaxants, other drugs, non-drug methods, surgical operations.

general information

Eyelid twitching is called myokymia. The symptom is often found in the population, including in people who do not suffer from neurological, ophthalmic or mental pathologies. The upper eyelid twitches more than the lower. In the absence of diseases, the manifestation occurs briefly, in the vast majority of cases - on the one hand. In the presence of provoking diseases, it can persist for a long time, spread to the lower eyelid and half of the face.

Why does the upper eyelid twitch?

Physiological causes

In a healthy person, twitching of the upper eyelid is potentiated by the following factors:

  • stressful conditions. With intense acute or moderate chronic stress, the symptom is caused by pronounced negative emotions and psycho-emotional overstrain.
  • Lack of sleep. Due to poor quality or insufficient sleep, the muscles in the upper eyelid area do not relax. Prolonged overvoltage causes twitching.
  • High visual load. It is observed with the wrong selection of glasses and contact lenses, prolonged work at the computer or using gadgets.
  • Medicines and drinks. The disorder may occur during the intake of alcohol, abuse of caffeinated drinks, treatment with antihistamines and some antidepressants.

Neuritis of the facial nerve

Pathology often manifests as pain behind the ear. After some time, one-sided twitching of the eyelid becomes noticeable, followed by the development of facial asymmetry: drooping of the corner of the mouth, smoothing of the nasolabial fold, inability to completely close the eye. Mimic movements with neuritis on the affected side are weakened or absent, taste sensations are reduced. Possible tearing.

brain stem neoplasia

Brainstem tumors are characterized by significant variability in symptoms due to the large number of different structures located in this area. The symptom occurs due to compression or germination of the nucleus of the facial nerve, accompanied by other manifestations of neuritis. Possible strabismus, nystagmus, hearing loss, impaired coordination of movements, less often - paresis.

Idiopathic blepharospasm

It is a variant of local torsion muscular dystonia, which develops against the background of circulatory disorders and organic lesions of cerebral structures. At the initial stage, blepharospasm is manifested by non-intense twitching of the eyelids, which subsequently turns into bilateral squinting, which is not amenable to conscious control. Attacks last on average 3-5 minutes, occur without connection with external influences. Subsequently, spasms spread to the muscles of the face and neck.

Upper eyelid twitching


Other neurological diseases

Twitching of the upper eyelid can be observed with the following diseases:

  • Lateral amyotrophic sclerosis. The time of appearance of the symptom depends on the form of pathology. At the initial stage, the symptom is sometimes detected in ALS with progressive bulbar palsy. In patients with cervical and lumbar onset, the disorder joins at the advanced stage.
  • Multiple sclerosis. There are many manifestation options, including eyelid twitching, optic neuritis, nystagmus, and dizziness. Leg weakness and numbness are often noted. Subsequently, paresis, cerebellar and pyramidal disorders are formed.
  • Guillain-Barré syndrome. As a rule, the first manifestations are sensory disturbances and muscle weakness, spreading from the lower extremities to the upper ones. In some cases, early signs are twitching of the upper eyelid, oculomotor disturbances, dysphagia and dysphonia. Then symmetrical paresis of varying severity develops.
  • Neuromyotonia. Constant twitching of various muscles, including the muscles of the upper eyelids, is the main symptom of pathology. Increased muscle tension, prolonged tonic contractions, postural instability, autonomic disorders are noted.
  • Machado-Joseph disease. Fasciculations in the area of ​​the upper eyelids, other parts of the face and body are more common in types 1 and 3 of the disease. In type 1, paraparesis, ophthalmoplegia, exophthalmos, nystagmus, secondary parkinsonism are found, in type 3 - polyneuropathy and diffuse muscle atrophy.

Ophthalmic diseases

Dry eye syndrome is a polyetiological pathology that can be triggered by the following conditions:

  • Autoimmune diseases: Sjögren's syndrome.
  • Changes in the hormonal background: menopause, pregnancy, ophthalmopathy against the background of endocrine disorders.
  • Skin lesions: pemphigus.
  • Ophthalmic problems: chronic conjunctivitis, lagophthalmos, neuroparalytic keratitis, lacrimal gland dysfunction, condition after some eye surgeries.
  • Taking medications: antihypertensive drugs, hormonal contraceptives, anticholinergics, beta-blockers.
  • Overwork: prolonged work with a PC, long TV viewing.

The manifestation occurs against the background of a feeling of sand, cramps, burning and redness of the eyes, increased photosensitivity, lacrimation. Manifestations intensify in the evening. The symptom is also observed in allergic conjunctivitis, due to the release of histamine. The patient is concerned about burning, severe itching, swelling and redness of the conjunctiva.

Mental disorders

Twitching of the upper eyelid is found in neuroses in adults. Most characteristic of neurasthenia, mental disorders with a predominance of vegetative and somatic symptoms. As part of the neurosis in children, it is also found in neurasthenia, sometimes in obsessive-compulsive disorder. It is a characteristic sign of one of the varieties of an oligosymptomatic neurotic disorder - tics.


Diagnostic measures are carried out by a neurologist. Patients with eye diseases are referred for a consultation with an ophthalmologist. If a neurosis is suspected, the participation of a clinical psychologist, psychotherapist or psychiatrist is required. The specialist specifies the time of the first appearance, the frequency and duration of attacks, and identifies other complaints. As part of an additional examination, the following procedures are prescribed:

  • Neurological examination. Healthy people have no disorders. With neurosis, a slight increase in reflexes is possible. Patients with neuritis have asymmetry, unilateral paresis of varying severity. With other neurological pathologies, paresis, cerebellar ataxia, ophthalmoplegia, sensitivity disorders, and other disorders can be determined.
  • MRI of the brain. It is the leading diagnostic technique for differentiating tumors, idiopathic blepharospasm, multiple sclerosis, ALS and other neurological lesions. Allows you to determine the nature, localization and prevalence of the pathological process, assess the state of cerebral structures, membranes, intracranial vessels. To increase the information content, it can be carried out using contrast.
  • Electrophysiological methods. Patients with idiopathic blepharospasm are prescribed rheoencephalography to exclude the ischemic nature of the pathology. In ALS, neuritis and multiple sclerosis, electromyography, electroneurography, the study of evoked potentials are used to clarify the level of damage, assess the speed of impulse conduction, and detect fasciculations and fibrillations.
  • Ophthalmic research. In allergic conjunctivitis, during the examination, characteristic changes are determined (redness, swelling, hyperplasia of the papillae). With dry eyes, biomicroscopy, a fluorescent test, a Schirmer test are performed. Patients with idiopathic blepharospasm perform ophthalmoscopy and biomicroscopy of the eye.

The determination of the allergen that causes allergic conjunctivitis, depending on the stage, is carried out by skin-allergic or provocative tests. Sometimes, with ophthalmic pathologies, microscopy, microbiological or cytological examination is prescribed. Patients with ALS undergo a DNA test, a muscle biopsy, followed by a histological analysis.

Ophthalmic examination



Help at the prehospital stage

With episodic twitching of the upper eyelid, it is recommended to exclude provoking factors: reduce the level of stress or visual load, get enough sleep, give up alcohol and caffeine. It is worth paying attention to your psycho-emotional state, perhaps using the help of a psychologist.

If you are taking medications that can cause symptoms, you should contact your doctor to reduce the dose or change the drug. If the violation persists for a long time, extends to both eyelids or both eyes, other muscles, a specialist consultation is required.

Conservative therapy

The tactics of treatment are determined taking into account the nature of the provoking pathology:

  • Damage to the facial nerve. At the initial stage, glucocorticoids, vasodilators and decongestants, solux are used. From the second week, UHF, exercise therapy, massage are prescribed, from the third - phonophoresis and ultrasound. If residual effects persist for 2-3 months, biostimulants are recommended.
  • Idiopathic blepharospasm. In the debut, acupuncture and psychotherapy can be effective. Subsequently, botulinum toxin injections are carried out, anticholinergics and benzodiazepines are used. Sometimes muscle relaxants, antidepressants, antipsychotics are additionally prescribed. With xerophthalmia, topical eye moisturizers are indicated.
  • BASS. Non-drug measures include physiotherapy exercises, the use of orthopedic devices. With bulbar disorders and respiratory disorders, special nutrition, oxygen inhalations, and mechanical ventilation are required. As part of drug therapy, anticholinergics, anticonvulsants, and muscle relaxants are used. Mucolytics are useful for clearing the airways.
  • Multiple sclerosis. During periods of exacerbations, pulse therapy with glucocorticoids is carried out, sometimes plasmapheresis. In the remission phase, immunomodulators and immunosuppressants are prescribed. Symptomatic treatment includes antidepressants, beta-blockers, anticonvulsants, muscle relaxants, anticholinergics.
  • Ophthalmic diseases. With xerophthalmia, artificial tear preparations, immunotropic, anti-inflammatory, metabolic agents are instilled. Allergic conjunctivitis is an indication for the use of antiallergic eye drops and general antihistamines.

With inoperable neoplasia of the trunk, chemotherapy and radiation therapy are performed. The chemotherapeutic effect is carried out using several cytostatics.


If indicated, the following surgical interventions are performed:

  • Neuritis: suturing of the nerve or neurolysis in case of traumatic injuries, plastic surgery of the nerve using an autograft (within a year from the onset of the disease).
  • Tumors: removal of a neoplasm of the brain stem, stereotaxic surgery using CyberKnife or GammaKnife.
  • Idiopathic blepharospasm: blepharoplasty or transection of the corresponding branch of the facial nerve.
  • Xerophthalmia: plastic or obturation of the lacrimal openings, laser coagulation, diathermocoagulation; keratoplasty for corneal ulcers.