Eye Twitching: Why It Happens and What to Do

Written by Vasileios Skouteris MD, FEBO, Ophthalmic Surgeon

Page contents

1. What is eyelid twitching?
2. The most common causes of eye twitching
3. Left or right eye twitching: what does it mean?
4. What you can do to make it stop
5. When eye twitching needs an ophthalmologist
6. Blepharospasm and hemifacial spasm: the more serious forms
7. What happens during the examination
8. Frequently Asked Questions

Eye twitching, or more accurately eyelid twitching, is a small, involuntary contraction of the muscle that closes the eyelid. It usually affects the lower lid of one eye, lasts from a few seconds to a few minutes and keeps coming back for days or weeks. In the vast majority of cases it is harmless and linked to stress, tiredness, caffeine or dry eyes. Below you will find all the causes in detail, from magnesium to screens, what you can do about it and when you need to see an ophthalmologist.

What is eyelid twitching?

The medical term is eyelid myokymia. It consists of small, rhythmic contractions in a few fibres of the orbicularis oculi, the muscle that closes the eye. You feel them strongly, like a “flutter” or a “pulse” in the eyelid, but they are usually so small that other people do not even notice them, even when looking closely.

Myokymia is not an eye disease and does not affect your vision. It is a sign that the nerve endings controlling the muscle are “irritated” or overexcited. That is why it appears more often during periods of pressure, little sleep or a lot of caffeine, and goes away on its own when those conditions change.

The most common causes of eye twitching

1. Stress and anxiety

This is the most common cause. During periods of intense pressure, before exams, during busy weeks at work or at times of personal difficulty, the nervous system is on high alert. Stress hormones make nerves and muscles more excitable, and the eyelid is one of the first places to show it. Many people notice that the twitching appears exactly on the days they are under most pressure and stops when they are on holiday.

2. Tiredness and lack of sleep

Too little or poor-quality sleep often goes hand in hand with stress and has the same effect. After a few nights of short sleep, the eyelid starts to twitch, especially in the afternoon and evening. Catching up on sleep is often enough to make it stop.

3. Caffeine

Coffee, tea, cola drinks and energy drinks contain caffeine, which stimulates the nervous system. In large amounts or in sensitive people, it can cause eye twitching. If you drink a lot of coffee to get through tiredness, the two causes add up.

4. Alcohol and smoking

Alcohol, especially in larger amounts or the morning after, and nicotine also affect how excitable the nerves are. In some people, one evening of fairly heavy drinking is enough to bring on twitching the next day.

5. Screens and eye strain

Hours in front of a computer and a phone tire the eyes in two ways. First, the muscles that focus on near objects work without a break. Second, when we look at a screen we blink much less, so the eyes dry out. Digital eye strain is often accompanied by burning, blurring at the end of the day and eyelid twitching.

6. Dry eye

When the surface of the eye does not have enough tears, or tears of the right quality, it becomes irritated. The irritation sends constant signals to the nervous system and can trigger eyelid contractions. Dry eye syndrome is very common in people who work at screens, wear contact lenses, live in air-conditioned spaces or are over 50. If the twitching comes with stinging, a gritty sensation or redness, dryness is a likely culprit.

7. Magnesium deficiency: myth or fact?

Magnesium is essential for nerves and muscles to work properly. When levels are genuinely low, cramps, muscle twitches and tremor can appear in various parts of the body, not only the eyelid. That is why linking magnesium with eye twitching makes sense.

The truth, however, is that severe magnesium deficiency is not common in healthy people with a varied diet, and scientific studies directly linking magnesium to eyelid myokymia are limited. Deficiency is more likely in people with a monotonous diet, heavy alcohol use or chronic diarrhoea, or in those who take certain diuretics or stomach medicines for a long time.

Foods rich in magnesium include green leafy vegetables, nuts, pulses, wholegrain cereals and dark chocolate. If you are thinking of taking a supplement, discuss it with your doctor first, especially if you have kidney problems or take other medicines.

8. Allergies

In allergic conjunctivitis, itching and rubbing the eyes release substances such as histamine, which irritate the tissues around the eye. Rubbing on its own also irritates the eyelid. It is not unusual for twitching to appear in spring together with the allergy.

9. Uncorrected vision problems

Mild astigmatism or long-sightedness that has not been corrected, or glasses that no longer match your prescription, make the eyes work harder to see clearly. This constant effort can show up as headaches, tiredness and twitching. After 40, early presbyopia is a common cause. An eye examination quickly answers the question.

10. Eyelid irritation

Blepharitis, a developing stye, an eyelash turning towards the eye or a small foreign body under the lid can irritate the muscle and cause contractions. In these cases there are usually other symptoms too, such as redness, tenderness or a foreign body sensation.

Certain medicines

Less often, some medicines that act on the nervous system can cause muscle twitches. If the twitching started after a change in your medication, mention it to the doctor who prescribed it. Do not stop any medicine without consulting them.

Left or right eye twitching: what does it mean?

Folk tradition has plenty of interpretations: that a twitching right eye means joy and a twitching left eye sorrow, or that someone is thinking of you. Medically, the side makes no difference at all. Twitching can occur in the left or right eye, in the upper or lower lid, and the causes are the same. It usually affects one eye at a time and sometimes “switches” sides from one episode to the next.

What matters is not the side, but whether the twitching stays limited to the eyelid, how long it lasts and whether other symptoms come with it.

What you can do to make it stop

Because the causes are usually everyday ones, the solution starts there too. Try the following for two to three weeks:

• Sleep more: Aim for 7 to 8 hours of sleep, on a regular schedule.
• Cut down on caffeine: Limit coffee to one or two cups a day and avoid energy drinks.
• Manage stress: Walking, exercise, breathing exercises and some screen-free time in the evening.
• Take screen breaks: Follow the 20-20-20 rule: every 20 minutes, look at something about 6 metres (20 feet) away for 20 seconds.
• Keep your eyes moist: Preservative-free artificial tears a few times a day help if there is dryness.
• Warm compresses: A warm, damp cloth on closed eyes for 5 to 10 minutes relaxes the muscle and helps if you have blepharitis.
• Gentle massage: Light circular movements with your fingertips over the closed eyelid can bring relief while the twitching is happening.
• Watch your diet: A varied diet with vegetables, pulses and nuts, and enough water throughout the day.

For most people, these changes make the twitching settle within a few days to a few weeks.

When eye twitching needs an ophthalmologist

Although it is rare, twitching can be a sign of a condition that needs diagnosis and treatment. Book an appointment if:

• The twitching lasts longer than two to three weeks, despite lifestyle changes
• The eyelid closes completely with each contraction, or you find it hard to open the eye
• The contractions spread to other parts of the face, such as the cheek or the corner of the mouth
• It happens in both eyes at the same time, with forceful blinking
• The eye is red, swollen, painful or has a discharge
• The upper eyelid has drooped or your vision has changed

You need urgent medical assessment if you develop weakness or “drooping” on one side of the face, double vision, difficulty speaking or numbness. These are not symptoms of simple eye twitching.

Blepharospasm and hemifacial spasm: the more serious forms

Two conditions stand apart from harmless myokymia and need treatment.

Benign essential blepharospasm

It usually appears after 50 and affects both eyes. It starts with increased blinking and sensitivity to light, and over time the eyelids close tightly and involuntarily, for seconds or even longer. At an advanced stage it makes reading, driving and everyday life difficult. It often coexists with dry eye, which makes it worse.

Hemifacial spasm

This affects one side of the face. It usually starts in the lower eyelid and gradually spreads to the cheek and the corner of the mouth. The contractions often continue during sleep. It is usually caused by a blood vessel pressing on the facial nerve, and your doctor may request an MRI scan to rule out other causes.

In both cases, the treatment of choice is botulinum toxin injections at specific points around the eye. They relax the muscle and the contractions are significantly reduced for three to four months, after which the treatment is repeated. You can read more about the procedure on our page on botulinum toxin injections, which are used for both cosmetic and medical purposes.

What happens during the examination

At the clinic, the ophthalmologist will ask when the twitching started, how often it occurs, whether it affects only the eyelid and what has changed in your daily routine. They will observe the contractions and use the slit lamp to examine the surface of the eye, the eyelids and the tear film for dry eye, blepharitis or other irritation. Your vision and prescription will also be checked. In most cases the examination is reassuring and you leave with specific advice. If there are signs of blepharospasm or hemifacial spasm, appropriate treatment is planned or you are referred to a neurologist.

If the twitching in your eye will not go away or is worrying you, call 210 677 0007 to book an appointment at our clinic in Neo Psychiko, Athens.

Frequently Asked Questions

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