You’re tired, overworked, stressed—and just when you go into an important meeting, your eyelid starts to twitch. You’re experiencing a blepharospasm, an uncontrollable contraction of the eyelid muscle, that makes you look just a little crazy and feels more than a little annoying.

Before you add a twitchy eye to your list of stressors, relax. Twitchy eyelids are not uncommon and are rarely cause for concern. In most cases, they result from eye irritation, too much caffeine, fatigue or stress.

“If it’s just the eyelid itself, it’s usually not anything bad,” says Dr. Whitney Brothers, an ophthalmologist with West County Ophthalmology at St. Luke’s Hospital. “And if nothing bad’s going on, then it tends to go away on its own.”

However, it’s a good idea to see your eye-care professional or primary-care physician if a twitchy eyelid persists. “Some people will come in and say their lid’s twitching, but their cheek and further down along the jawline is also twitching,” Brothers says. “So some people call it a lid twitch, but we recognize that it’s not just the lid, and that usually needs a further workup.”

Facial twitching that is not just confined to the eyelid can indicate an irritation or compression of the facial nerve, which requires a neurological assessment. The root cause of blepharospasm is thought to involve abnormal chemical transmission in the basal ganglia, a part of the brain that helps control movement. Blepharospasm also can be associated with neurodegenerative conditions, such as Parkinson’s disease, multiple sclerosis, Tourette syndrome and a number of other neurologic and metabolic disorders.

For some people, blepharospasm is a progressive neurological condition that feels more like uncontrollable blinking than slight twitching. “Benign essential blepharospasm (BEB) is a condition usually seen in people in their 50s and 60s,” explains Dr. Sophia Chung, a SLUCare ophthalmologist. “Early in the condition, the patients find themselves blinking more frequently with bright lights, fatigue and emotional stress. They complain of increased irritation and light sensitivity. But with time, the blinking becomes more frequent and more forceful with extended periods of eyelid closure.”

Careful administration of Botox to the muscles that are causing the spasms can provide relief for up to three months. Botulinum toxin is FDA-approved for this purpose and blocks nerve impulses that cause the twitching. “It is injected in tiny doses to specific sites along the eyelid and brow and is tailored to the individual patient,” Chung says. “Sometimes, the injections are insufficient, and some patients require eyelid muscle surgery, oral medications and, in extreme situations, deep brain stimulation.”

So consider a twitchy eye to be a sign that you may need more rest and relaxation. If the twitching continues and is interfering with your life, talk to your doctor to determine the cause and get relief.

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