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Why does my eye twitch?

By Joel Hunter, MD | 7/17/17 7:54 AM
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A good way to know if you’ve got a condition that is well-known or if you’re just weird is to find out if there is a name for your problem. For example, if your fingernails get shorter at night and grow during the day so that you never have to cut them, there’s not a name for that. Sure, that’s a weird example, but that’s the point: it’s not a known condition, it’s just weird. As a counterexample, if your eyelid twitches in some specific situations or at seemingly random times, that’s called eyelid myokymia. It’s not weird, it is just a physiologic condition.

Eyelid myokymia, commonly referred to as an eye twitch, affects about 98% of the population at some point according to a study I just did by thinking about how often I hear about it and making a number up. It’s really common, and it really annoys people. No one likes to have a part of their body doing something they didn’t tell it to do. It’s like what happens to me when “24K Magic” by Bruno Mars comes on the radio. It is unsettling to have no control over my arm when he says to put your pinky rings up to the moon.

The reason this is much more common in your eyelid than a muscle twitch or spasm elsewhere in the body is because the muscle in your eyelid is so remarkably thin. Your orbicularis oculi muscle is an ultra-thin sheet of concentric rings that center on your eye. Ever wonder why crows feet show up where they do? It’s that muscle contracting over the years when you squint, or laugh, or smile, or eye someone suspiciously.

Muscles usually contract when a nerve tells them to (and nerves fire when you tell them to). It happens by opening a bunch of channels to move sodium and potassium into or out of the muscle cells. You’ll find these chemicals, called electrolytes in this setting, in table salt and bananas, as well as thousands of other less specific food examples. What happens with an involuntary twitch is that the normal chain of command—your brain, your nerve, your muscle—is subverted. The muscle contracts when you didn’t ask it to because of an imbalance of electrolytes or a rogue nerve activating without central command’s blessing.

The three big causes of this are dehydration, stress, and/or fatigue. Dehydration is the usual cause of the electrolyte imbalance (it’s almost never because someone ate 20 bananas), and stress or fatigue can cause nerves to fire without you asking them to. Big, beefy muscles have a lot of volume and stability and require a lot more to activate than that wafer thin orbicularis oculi muscle in your lid. If things are a little off, that eyelid muscle is usually the first to get affected.

The treatment, based on the causes of the twitching, would be to drink Gatorade (smiling knowingly at the word “electrolytes” on the label) while laying in a hammock and taking a nap. Now you’ve knocked out all three causes in one extremely relaxing, surgical strike. If that doesn’t work, you can text me about it like my nephew Noah did, who was my inspiration for this blog. I would like to dedicate this to him, and say he’s in our thoughts as he recovers from a recent bout of eyelid myokymia.

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