Lid twitching, also known as Myokymia, is the spontaneous contracting of the eye lid muscles around the eyes. It involves, but may not be limited to, the obicularis oculi muscle. Most often it is caused by stress, fatigue, caffeine or alcohol intake and on rare occasions neurological anomalies. The majority of cases are benign and self limiting.

The oldest and most recommended treatment had been over the counter quinine. The efficacy of the therapy involved increasing the refractory period and therefore decreasing the excitability of the obicularis muscles. In December of 2006, the FDA removed quinine from the OTC ranks due to potentially dangerous side effects including leg cramps, cardiac arrhythmia, renal failure, thrombotic issues and decreases in vision and hearing. The FDA reacted as a result of 655 reported cases of such conditions. Quinine is now used mainly for the treatment of Malaria and is closely regulated.

Topical antihistamines have been used as a very effective treatment, but the actual results have never been studied. We have used them with excellent results. Additionally, betaxolol, a glaucoma drug, used twice per day has also been effective in stopping the twitches. Finally, the use of Botulinum toxins in severe cases works well, but is accompanied by potential side effects as well.

The simplest therapy is to attempt to reduce the stress, use cool compresses and when needed use the topical antihistamine. In all cases, see your eye doctor if the symptoms do not go away within a few days.