This is a common, annoying complaint in which 98% of cases have unilateral involvement, but often a history of contralateral attacks. It consists of spasms in one or both eyelids of one eye. The patient notices the spasms as very obvious and thinks that other people nearby can also see these spasms. In fact, the spasms are so slight that other people can only see them if they get very close to the patient. The patient’s own close proximity to the spasms makes them seems more obvious than it actually is. This phenomenon is called blepharomyokymia.

Predisposing factors are fatigue, stress, caffeine, other stimulants, CNS depressants, decongestants, possible ocular fatigue due to small uncorrected refractive error, especially slight astigmatism for people with work that involves a demanding visual task.

The underlying cause is orbicularis fatigue, leading to spasms, causing more fatigue, and more spasms.

Management consists of reassurance, advice to reduce intake of stimulants, reduction in stress, increased rest and relaxation, attempts to enhance the quality of sleep, and where clinically appropriate correction of small refractive errors and the recommendation of topical anti-histamine drops 4-5 x daily and/or oral anti-histamine. If the medication route is taken, efficacy can be assessed after 4-5 days.