Heard of Myokymia?

I have been consuming an average of 3 “Starbucks mug” amount of coffee for the past 2 months. For one, supply of coffee is ‘bottomless’ in my workplace and, given the location and facilities, it’s the only thing I can do to take a break from what I’m doing. Except for frequent trips to the urinal, I wasn’t experiencing any other side effects of excessive caffeine intake, until last week. I started to have lower eyelid twitching several times a day. I knew it was due to caffeine because I read it somewhere before that muscle twitches can sometimes be precipitated by caffeine, among others. I tried to look this up and here is what I found about it.

Myokymia is the spontaneous, fine fascicular contractions of muscle without muscular atrophy or weakness. Eyelid myokymia typically involves the orbicularis oculi muscle of one of the lower eyelids; occasionally, the upper eyelids also can be affected. In most cases, it is benign, self-limited, and not associated with any disease. Intervention is seldom necessary. Rarely, it may occur as a precursor of blepharospasm, Meige syndrome, hemifacial spasm, and spastic-paretic facial contracture.

The pathophysiology of typical eyelid myokymia is not well understood. The focus of irritation is most likely the nerve fibers within the muscle. However, pontine dysfunction in the region of the facial nerve nucleus also has been implicated. Possible precipitating factors include stress, fatigue, and excessive caffeine or alcohol intake.

This is a benign and self-limited condition in most patients, and may occur at any age.

Reassurance and reduction in precipitating factors (like caffeine), if identifiable, are appropriate for most patients. Treatment is usually not needed except when symptoms are severe or when oscillopsia is present. Local subcutaneous botulinum toxin A (BOTOX®) injections of 2.5-5 units each to the affected eyelid region provide relief for 12-16 weeks. If the upper eyelid is involved, the injections should not be placed near the levator palpebrae; otherwise, ptosis lasting weeks will result. Adverse effects include temporary lid laxity, which may produce lagophthalmus, exposure keratopathy, and ptosis. The efficacy of other agents has not been proven.

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