The question:

Is it true that stress can cause your eyelid to twitch?

The science:

Many people have experienced it — that twitch that causes an eyelid to wiggle for several seconds. Twitches of the eyelid muscles may feel weird but are typically harmless and have been associated with stress, lack of sleep and caffeine use, among other culprits.

The exact mechanism that causes the twitch is not completely understood, but it occurs randomly and usually resolves within seconds, ophthalmologists said.

The eyelid muscle responsible for opening and closing the eyelid, the orbicularis oculi, “is the fastest-working muscle in the human body, so when it goes into a spasm, it goes into a spasm,” said Stephanie Marioneaux, an ophthalmologist and a spokeswoman for the American Academy of Ophthalmology. The muscle can close an eyelid in less than 100 milliseconds and reopen it in about 200 milliseconds.

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In rare cases, eyelid spasms may be debilitating and require treatment. A blepharospasm causes one or both eyes to close involuntarily. Although benign, blepharospasms can become chronic and, over time, increase in frequency, making it difficult to perform daily tasks.

With hemifacial spasms, a neuromuscular disorder, an eyelid spasm progresses to incorporate the brow and muscles in the lower face, often pulling the mouth to one side.

Eyelid spasms differ from eyeball spasms, ophthalmologists said. If it appears that the world is moving with each spasm, consult an ophthalmologist or neurologist.

What else you should know:

A simple eye twitch does not require treatment. If the twitches persist or start to involve other muscles in the face, consult an ophthalmologist.

Blepharospasms and hemifacial spasms can be treated with regular injections of botulinum toxin. Also known by the brand name Botox, the medication produced from the bacterium Clostridium botulinum, temporarily blocks nerves thereby weakening or paralyzing certain muscles.

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In severe cases of blepharospasms that do not respond to the injections or for people who are afraid of needles, deep brain stimulation implantation may be considered, said Andrew Carey, associate professor of ophthalmology and neurology at Johns Hopkins University.

Microvascular decompression surgery may be considered in some cases for hemifacial spasms to relieve pressure on the facial nerve causing the spasms, but surgical options are invasive and can carry certain risks, ophthalmologists said.

The bottom line:

Eyelid twitches are typically harmless. But if the twitch bothers you, try to reduce stress, get enough sleep and lower caffeine intake, medical professionals said.

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