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Why does your eyelid go through twitching phases?

-- Anya

Myokymia, or involuntary eye twitching, is a condition that many of us are familiar with. And it seems everyone has an opinion on what triggers it: Is it fatigue? Eye-strain? Stress?

"Most of the time, myokymia is idiopathic, which is a fancy way of saying we have no idea why it happens," says Dr. Andrea Thau, an associate clinical professor at SUNY Optometry and a spokesperson for the American Optometric Association. "It’s such a benign condition, and tends to resolve on its own, so there's little incentive to research it."

Essentially, myokymia is a twitch -- an involuntary muscle spasm in the upper eyelid muscle that causes a fluttery sensation. The trick to stopping it, according to Thau, is to "break the twitch." She recommends trying alternating hot and cold compresses, which can soothe the overactive nerve that's causing the spasm. If that doesn't work, "try drinking a glass of tonic water," she recommends. "The quinine helps nerve impulses."

Some doctors will prescribe antihistamines for particularly stubborn or enduring eye twitches. If eyes are a bit swollen -- due to low-grade allergic reaction -- that can cause the nervous system to overreact and trigger a twitch.

Huffpost Wellness Editor Patricia Fitzgerald has observed clinically -- which is to say, in an observational, rather than a scientifically rigorous research setting -- that patients of hers have mentioned fatigue and stress in connection to eyelid twitching. Fitzgerald finds that many of her patients' twitches are resolved by acupuncture.

In very rare instances, eyelid twitching can indicate a more serious condition, like the beginning stages of multiple sclerosis or a lesion on the brain stem. Those conditions typically begin with a host of symptoms, and in this circumstance the eyelid twitch soon moves to the facial muscles, as well. It's so rare, in fact, that Thau says she's never seen it in clinic herself.

There is another condition that affects the eyelid muscles, a rare disorder called blepharospasm, in which the eyelids involuntarily close. This can take the form of brief, excessive blinking or squinting and can progress to full eye closure, according to Mary Smith of the Benign Essential Blepharospasm Research Foundation. Blepharospasm affects about 60,000 Americans, and is more likely to affect women and those over 40, Smith says. "It can be problematic, if you don’t know when your eyes are going to shut, you may walk into things or fall," she says. "It’s definitely debilitating."

There's a genetic component to blepharospasm and also a trigger -- sometimes trauma, a secondary condition like dry eye or even external factors like bright or rapidly changing lights. It is most commonly treated with regular Botox injections and, interestingly, blepharospasm was among the conditions listed during Botox's first FDA approval in 1988, according to Smith.

If you experience occasional eye twitches, chances are it's a benign. But it's important to get your eyes checked each year by an ophthalmologist or doctor of optometry to rule out any other problems. Even if it's simply eye strain or stress causing the twitch, it could indicate a need for glasses.

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