Do your eye­lids twitch once in a while? This twitch­ing, called fas­ci­c­u­la­tion, is pret­ty com­mon-and it can af­fect the up­per eye­lids, in­volve mus­cles in the low­er eye­lids, or both. The twitch may hap­pen in one or both eyes and can oc­cur spon­ta­neous­ly and un­con­trol­lably. And once it starts, eye twitch­ing can con­tin­ue off and on for sev­er­al days or longer and then dis­ap­pear.Eye doc­tors are not sure what caus­es eye­lids to twitch, but they be­lieve it may of­ten be re­lat­ed to stress and fa­tigue. In some cas­es, the cause of a twitch­ing eye con­di­tion may nev­er be iden­ti­fied."The most com­mon caus­es of twitch­ing eye in­clude stress, lack of sleep, and ex­cess caf­feine," says Al­ber­to Mar­tinez, MD, an oph­thal­mol­o­gist in Bethes­da, Md, and a spokesper­son for the Amer­i­can Acad­e­my of Oph­thal­mol­o­gy.

Oth­er caus­es can in­clude eye ir­ri­ta­tion, eye strain or dry eyes.In rare cas­es, a twitch­ing eye may be an ear­ly sign of a neu­ro­log­i­cal dis­or­der such as ble­pharospasm (an ab­nor­mal blink­ing or spasm of the eye­lids) or amy­otroph­ic lat­er­al scle­ro­sis (ALS), more com­mon­ly known as Lou Gehrig's dis­ease. Twitch­ing eye con­di­tions that are more se­ri­ous, such as those in which the eye­lid com­plete­ly clos­es and has se­vere con­trac­tions, are of­ten caused by ir­ri­ta­tion of the cornea (the sur­face cov­er­ing the iris and pupil) or the con­junc­ti­va (the mem­brane that lines the eye­lids and white of the eye).

What your eye doc­tor will look for

If your eye­lid twitch does not go away in a week, or if symp­toms be­come worse or you are both­ered by the twitch, you should be eval­u­at­ed by an eye doc­tor. Your doc­tor will per­form a com­pre­hen­sive eye ex­am to rule out eye dis­eases and con­di­tions such as dry eye. He will al­so look for oth­er symp­toms that may be ac­com­pa­ny­ing the twitch­ing eye, such as sen­si­tiv­i­ty to light. Eye­lid twitch­es that trav­el down the face or in­volve oth­er fa­cial mus­cles are def­i­nite­ly cause for fur­ther eval­u­a­tion.Your doc­tor will check for oth­er symp­toms such as gri­mac­ing or fa­cial spasms, and will prob­a­bly re­fer you to your pri­ma­ry care physi­cian for fol­low-up.

Treat­ing twitch­ing eyes

In most cas­es, a mi­nor eye­lid twitch does not re­quire treat­ment and will go away on its own. In some in­stances, just go­ing to the eye doc­tor for an eval­u­a­tion can help al­le­vi­ate symp­toms."Do­ing a full eye ex­am can al­most have a place­bo-like ef­fect," says Dr Mar­tinez.Do­ing what you can to re­duce stress, get­ting more sleep, and cut­ting down on your caf­feine in­take can help re­lieve twitch­ing eye. "You can al­so try warm com­press­es to re­lax the mus­cles around the eyes," sug­gests Mar­tinez.If the eye­lid twitch is se­vere, your doc­tor may re­fer you to a neu­ro-oph­thal­mol­o­gist, who may of­fer you pro­vides bot­u­linum tox­in in­jec­tions, oth­er­wise known as Botox, to tem­porar­i­ly stop the spasms. Sur­gi­cal op­tions, such as a myec­to­my-a pro­ce­dure that in­volves re­mov­ing or cut­ting some of the mus­cles and nerves of the eye­lids-may re­lieve some symp­toms of se­vere ble­pharospasm.So don't get stressed about a lit­tle twitch. But if symp­toms per­sist and are both­er­some, see your doc­tor to rule out more se­ri­ous eye and neu­ro­log­i­cal prob­lems.