Why is my eyelid twitching and is it related to TED?

Some people with thyroid eye disease tell us that they experience sensations of eyelid twitching or flickering, and ask whether this is part of thyroid eye disease. It is actually most likely to be something called myokymia, which can affect anyone but may be more common in people with TED.

What is myokymia?

The eyelids contain a layer of flat muscle (‘orbicularis oculi’) that serves to close the eyes when it contracts. Sometimes a small portion of this muscle starts contracting repeatedly and uncontrollably, resulting in a twitching of the lid. This is called myokymia.

Myokymia is more common in the lower lid and usually affects one eye at a time. Often the movements are so small they are felt rather than seen, but sometimes the eyelid can be seen to be twitching on close inspection.

Is it due to thyroid eye disease?

No, it is not directly due to TED and can affect anyone, although anecdotally it seems to be quite commonly experienced by people with TED.

Myokymia can be triggered by stress, anxiety and tiredness, which are unfortunately common experiences in those affected by TED. It can also sometimes also be triggered by exercise, or by excess caffeine.

Is it dangerous?

No, myokymia itself is almost never a sign of another serious underlying diagnosis. Very rarely, persistent cases turn out to be due to neurological conditions.

Is there any treatment?

In most cases myokymia settles by itself within days to weeks. The following measures may help to reduce symptoms:

Reduce caffeine and alcohol intake. Excessive consumption can contribute to muscle twitching.

  1. SLEEP. Try to get more sleep as insufficient rest can exacerbate symptoms
  2. REDUCE/MANAGE STRESS. Stress is a common trigger for myokymia
  3. CHECK FOR NUTRITIONAL IMBALANCE. Deficiencies in certain vitamins and minerals, such as magnesium, can play a role.
  4. MINIMISE DIGITAL DEVICE USE. Prolonged use of digital devices can lead to muscle fatigue and twitching.
  5. CHECK YOUR MEDICATION. Some medications have side effects that include muscle twitching.

If the symptoms persist for more than a couple of months, you should be assessed by an ophthalmologist as there may be a need for a scan or other examinations.

For persistent cases, botulinum toxin (botox) injections can be used to block the twitching muscle and relieve the symptoms, and this treatment can be given one or more times at 3 month intervals depending on whether symptoms recur.

This article was written by Rebecca Ford, consultant oculoplastic surgeon at the Bristol Eye Hospital, in response to questions on our TEDct Facebook forum. Members reported experiencing this annoying problem. If you have any suggestions for future articles you can send them via the Facebook forum Thyroid Eye Disease Support UK or email them to info@tedct.org.uk.