When to Worry About Eye Twitching

Eye twitching is common. How do you know when it's benign and when it's a sign of something more serious? 

Sanaz Majd, MD,
Episode #204

Physical Exam

I see that my wonderful nurse has already completed a screening vision exam prior to my visit with her, and as expected Eileen has normal vision. I then exam Eileen’s eyes with a special scope to visualize the back of the eye, in addition to examining her eye range of motion and peripheral vision.  I also perform a complete neurologic exam (including other parts of the body).  And her entire examination appears to be completely normal, as most people with eye twitching. I did get to see her left lower eyelid twitch a few times during our visit, however.

Treatment of Eye Twitching

Given that her exam was completely normal, and that her history indicates more benign causes of eye twitching, I ask Eileen to do the following for the next few weeks and then to return in 3-4 weeks to re-asses:

·         Drink no more than one cup of coffee a day (as in her baseline) or stop it altogether

·         Stop drinking Alcohol if she’s drinking any

·         Drink plenty of fluids (drink to thirst, no need to overdo it)

·         Make sure to wear her glasses at work for near vision

·         Give her eyes a break every 20 minutes computer use

·         Use artificial tears several times a day, especially while at work

·         Continue to get good sleep each night


When I saw Eileen back in the office five weeks later, she tells me that she is much improved. Like many medical conditions, her eye twitching was actually “multifactorial” (meaning due to several factors, not just one). It may have been improved by any of the following factors:

·         She’s taking a diuretic for her high blood pressure (although no need to stop it at this junction)

·         Drinking more caffeine than usual

·         Eye strain due to increased computer use because of tax season

·         Dry eyes (the weather in Southern California—just think desert)

So as you can see, each risk factor alone may not cause any symptoms.  But compound it all together, and voila!, you have a problem.  

Most eyelid twitching is not serious and self-resolves. It is also typically only on one side, involves the lower eyelid (but not always), and can last for weeks to months intermittently.

When Should You Worry About Eye Twitching

You should see your doctor if:

·         The twitching persists for weeks despite some minor changes discussed above

·         The twitching worsens through time

·         There’s associated light sensitivity

·         If there is twitching of other parts of the face

·         It’s severe enough to cause the eyes to shut close with each twitch

·         There’s difficulty opening the eyes or there is a droopy eyelid

·         There are any other neurological symptoms (numbness, motor deficits, speech deficits, visual field deficits, etc)

·         There’s blurry vision or any problems with the vision

·         There is associated redness, swelling, or abnormal discharge from the eye

Another mystery diagnosis ... solved.

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Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.



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