Bilateral Eyelid Twitching in a Young Adult Female

Case at a Glance

A 26-year-old female presents with a 2-month history of persistent left eyelid twitching, with recent onset of right eyelid involvement.

Patient's Story

The patient reports experiencing intermittent twitching of her left eyelid for approximately two months, occurring multiple times daily. The twitching episodes happen spontaneously throughout the day without any apparent triggers. Recently, she noticed similar twitching beginning in her right eyelid. She denies any associated pain, vision changes, or other neurological symptoms. The patient appears concerned about the persistent nature of the symptoms and their recent bilateral progression.

Initial Assessment

Physical examination reveals a well-appearing 26-year-old female with BMI of 41.7 (height 5'5", weight 250 lbs). Vital signs are stable. Neurological examination shows intermittent fasciculations of the left eyelid muscles with occasional involvement of the right eyelid. No other focal neurological deficits are observed. Visual acuity and extraocular movements are normal. No signs of thyroid dysfunction or other systemic abnormalities noted on initial assessment.

The Diagnostic Journey

Initial differential diagnosis included benign essential blepharospasm, caffeine-induced myokymia, sleep deprivation effects, nutritional deficiencies, and stress-related muscle fasciculations. Given the bilateral progression and persistent nature, further evaluation was considered to rule out secondary causes including electrolyte imbalances, thyroid dysfunction, and neurological conditions.

Final Diagnosis

Benign essential blepharospasm (eyelid myokymia), likely multifactorial in origin with contributing factors including possible sleep deprivation, caffeine consumption, and nutritional deficiencies.

Treatment Plan

Conservative management approach focusing on lifestyle modifications: optimization of sleep hygiene with target of 7-8 hours nightly, reduction of caffeine intake, stress management techniques, and nutritional assessment with consideration for magnesium and B-vitamin supplementation. Patient education provided regarding benign nature of condition and expected improvement with lifestyle changes.

Outcome and Follow-up

Patient advised to monitor symptoms and return if twitching persists beyond 4-6 weeks of conservative management, worsens significantly, or if new neurological symptoms develop. Follow-up appointment scheduled in 6 weeks to assess response to treatment modifications.