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.

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Nature has designed us for efficiency and effectiveness. We have body hair to keep us warm, nose hair to filter out debris and eye lashes for protection. The lashes have become more then just feelers and filters for many folks. There are those that apply false eyelashes, some use mascara and others make up to extend and fill them out.

Recently there is a topical glaucoma medication that has been ‘off-labeled’ approved to enhance eyelash growth and thickness, Latisse. While Latisse can improve the appearance of one’s lashes, a change in their growth pattern or in them turning inward can result. Trichiasis is a condition whereby the eyelashes grow inward toward the cornea. When this occurs there is an increased predilection for them to rub against the eye resulting in scratches on the cornea, pain and even scarring if left untreated.

Regardless of how eyelashes are managed, occasional discomfort upon blinking is a result of these lashes rubbing against the cornea. Careful examination is required to determine if this is the case. The most often employed treatment is called Epilation. This is simply plucking out the offending lashes so they do not damage the cornea. Frequently, the patient must return every several months for additional Epilation, to eliminate the offending source. In some cases when there are many lashes growing in, a bandage contact lens must be worn in addition to the lash removal.

In short, if you feel a foreign body sensation upon blinking, see your eye doctor because some lashes may have to be epilated.

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