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Health answers: What causes persistent eyelid twitch?

Q. What causes a persistent eyelid twitch?

A. It’s a mystery why many of us occasionally experience a strange, involuntary quivering in the eyelid, which appears at random intervals and can persist for days. “It’s just a branch of the so-called facial nerve that happens to just be firing intermittently or twitching,” says Neil R. Miller, a neuro-ophthalmologist at the Wilmer Eye Institute at Johns Hopkins Hospital.

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The spasm — myokymia is the technical term — is often brought on by excess caffeine, too little sleep, or a period of stress. With better self-care, it usually goes away on its own. In some people, it can persist for weeks or months. Miller helped conduct a study on a group of such people that found no evidence that minor twitching is associated with more serious neurological conditions like brain tumors or multiple sclerosis. Miller says some people with severe cases benefit from an injection of botulinum toxin to quiet the rogue nerve.

Symptoms that are more pronounced or progress could indicate a more serious problem. A condition called blepharospasm involves excessive blinking or shutting of both eyes, and Meige syndrome is similar but extends into lower facial muscles; both can be alleviated with treatments like botulinum toxin, medications, or surgery. Hemifacial spasm extends to muscles on one side of the face, and can usually be cured with surgery. Long-term eyelid twitches can also be part of conditions like Tourette syndrome, Bell’s palsy, or can simply be tics that have become habitual.

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