Looking for help. Can you feel eyelid muscles “kicking” your eyes when you blink?

[hopeful_hiker]

Still trying to figure out my blinking conundrum. Had a TBUT of 8 and 10 as well as good osmolarity and some MMP9 inflammation yesterday.

When I blink, sometimes even in 80%+ humidity, I can feel my eyelids kick my eyes as I blink (some days blinks are also painful and/or scrapey). I have also experienced twitching in the lower eyelid for a year (on and off). I can often trigger it by slow blinks.

Sadly, because my blinks are often so weird (and I am OCD), I am constantly aware of blinking and blink manually unless I feel totally normal.

The doc suggested it is a neuro-muscular thing, some kind of minor blepharospasm? I feel totally ok if I slowly open and close eyes.

I feel worse in the car. In fact, even when I am a passenger, I am in blinking pain. As soon as I get out I am much better, usually just feel blinks not pain.


Any ideas?

[Guest]

Someone just posted that they had a dystonia that caused blepharospasm. She got Botox injections and got her life back, those were her words. So your doc may be correct on the blepharospasm. Now is it muscular or is it neurological? That would help direct treatment I assume.

EDIT: I was pacing around my room thinking about what you said about riding in a car. Do you think it’s the sun? Does this happen at night?

[Milo007]

When I blink, sometimes even in 80%+ humidity, I can feel my eyelids kick my eyes as I blink (some days blinks are also painful and/or scrapey). I have also experienced twitching in the lower eyelid for a year (on and off). I can often trigger it by slow blinks.

Sadly, because my blinks are often so weird (and I am OCD), I am constantly aware of blinking and blink manually unless I feel totally normal.

The doc suggested it is a neuro-muscular thing, some kind of minor blepharospasm? I feel totally ok if I slowly open and close eyes.

Any ideas?

I can understand exactly what you mean. I have been experiencing eyelid muscles twitching on an irregular basis for the last three years. In my case it all started when I was a computer game addict and would spend 12-16 hours a day playing video games. My right upper eyelid muscles would start twitching after a few hours of focused digital screen use. Yes it feels like the muscles are kicking your eyelids as you have described. Now that I have restricted my digital screen usage and don't play video games at all for the last 4 years the eyelid twitching rarely manifests.

At this point I would say it could be due to the following reasons :

1. Your eyelid muscles are becoming fatigued as your eyes are compensating a reduced TBUT with an increased frequency of blinking. I have experienced this myself when I consciously tried to blink too frequently at times. My eyelid muscles would suddenly start "trembling" after 2-3 hours and all I need is a nap of about an hour or two so that things become normal again.

2. Your eyelid muscles and nerves might have got stressed due to use of digital screens (assuming you were an avid digital screen user for some years) as it happened to me. A few months back I read a news report that narrated the case of a teenage boy in Indonesia whose facial muscles got paralyzed permanently and it happened suddenly in the middle of a video gaming session. Doctors said that chronic stress to the facial nerves while playing video games for 15+ hours a day was his only fault.

3. Injury to your cranial nerves that control eyelid movements via neurological stimulus (this could be rarely the case unless you remember some serious blow to your head).

The more I read your posts the more I am surprised to learn how similar our symptoms are!

I feel worse in the car. In fact, even when I am a passenger, I am in blinking pain. As soon as I get out I am much better, usually just feel blinks not pain

Do you feel the same in air conditioned spaces or in the car if the AC is not running?

[hopeful_hiker]

Dowork123 thanks for the response! I got in touch with the person who had mentioned blepharospasm but in their case, the blinking is involuntary and eventually the eyelids would get shut rendering the person unable to perform daily tasks.

In my case, it’s a reverse—I almost always control my blinking. However, maybe because of that, my blinking is no longer normal mimicking a slight blepharospasm. But that’s pure baseless speculation on my part.

[Guest]

Dowork123 thanks for the response! I got in touch with the person who had mentioned blepharospasm but in their case, the blinking is involuntary and eventually the eyelids would get shut rendering the person unable to perform daily tasks.

In my case, it’s a reverse—I almost always control my blinking. However, maybe because of that, my blinking is no longer normal mimicking a slight blepharospasm. But that’s pure baseless speculation on my part.

Do your eyes or eyelids feel sore? Are you blinking excessively? I assume so if you’re manually blinking all day. Does this happen with drops in too?

[hopeful_hiker]

Milo007 thank you for your response!

So to clarify, if I don't blink I am completely fine. My eyes don't twitch (except for the lower lid but always in the same spot) or close.

1. When I had lower TBUT (2-3s as opposed to 8-10s now), I did not have this problem right away. I would say it started 3 months after the diagnosis. It seems better in higher humidity though but not always. Perhaps, my manual/conscious blinking was wrong? Maybe the natural movement is more slight and I did make the muscles weird?

2. I don't think it's screen related. Whether or not I use the screen does not seem to affect this symptom much. I would not call myself a heavy screen user but it was part of the dry eye trigger (one month of heavy use).

3. No injury.

Do you feel the same in air conditioned spaces or in the car if the AC is not running?

I feel more dryness sensation and scraping sensation in the malls, etc. However, in the car (no AC, no heating, humidity 45%-55%), I am in blinking pain very often. I don't wear moisture glasses most of the time but I tried them in the car and also no effect. It's a mystery.

[Milo007]

Milo007 thank you for your response!

So to clarify, if I don't blink I am completely fine. My eyes don't twitch (except for the lower lid but always in the same spot) or close.

1. When I had lower TBUT (2-3s as opposed to 8-10s now), I did not have this problem right away. I would say it started 3 months after the diagnosis. It seems better in higher humidity though but not always. Perhaps, my manual/conscious blinking was wrong? Maybe the natural movement is more slight and I did make the muscles weird?

2. I don't think it's screen related. Whether or not I use the screen does not seem to affect this symptom much. I would not call myself a heavy screen user but it was part of the dry eye trigger (one month of heavy use).

3. No injury.



I feel more dryness sensation and scraping sensation in the malls, etc. However, in the car (no AC, no heating, humidity 45%-55%), I am in blinking pain very often. I don't wear moisture glasses most of the time but I tried them in the car and also no effect. It's a mystery.

I am trying to relate your experience with my personal findings and since you have wrote you were not a heavy screen user for long enough and screens don't affect your blepharospasm, my guesses are :

1. You are blinking either too frequently than needed (this was the case with me when I was first diagnosed with MGD in July this year) or you are blinking too hard crushing your eyelid muscles everytime you blink (again this was the case with me since I was being extra careful about the fact that my opthalmologist told me that I was a partial blinker and my eyelids don't touch - Even now my lipiview says 67-100 % of my blinks are partial).

In this regard I would advise you to do two things and see if they make a difference. Firstly since your TBUT has gone up to 8-9 s train your eyes to blink every 5 seconds not earlier not later. So your eyes would need to blink on an interval that's comfortable for the eyelid muscles.

Secondly blink as hard as it's necessary to just touch your eyelids not harder to be extra cautious. You may take an optometrist's help in this regard who would tell you observing your eyes under a slit lamp microscope the degree of closure of your eyelids with varying efforts of blink. You should remember the 'feel' of the blink that's both comfortable and complete.

Also don't try to slow down your blink in an effort to make it more smooth or complete. Slowing down your blinks on a regular basis means excessive stress on your eyelid muscles and nerves which demands your eyelid muscles to sustain the tension longer than in a normal blink which is much quicker. Imagine you are doing a hand stretch with a dumbbell quickly and then slowly. The latter would fatigue your arm muscles in fewer repitions.

2. Your eyes are not getting enough rest. I assume you are a proactive person and you don't take rests too often. In that case your eyelid muscles are getting fatigued due to the overburden of an increased blink rate and they need rest.

Do you feel the same blinking pain an hour following some good hours of sleep?

If yes my second hypothesis is wrong.

I would advice you to put on moisture chamber glasses 24x7 for two or three weeks in a row to see if they make a difference. Because the increased TBUT would require lesser blinks on a daily basis and your eyelid muscles would get some time to heal. Also 8 hours of sound sleep and a few 30 minute naps when your eyes feel tired. This should help you troubleshoot if the problem is arising of eyelid muscle fatigue or some other eyelid condition.

[hopeful_hiker]

Milo007

1. I think like there is truth to your first point. Or at least I hope so. I noticed that when I would remember to blink, I would blink 2-3 times rapidly. I would also make the blinks super pronounced. Again, mainly because I also saw I am a partial blinker (easily seen with a slow motion recording on my phone). Also, I suffer from painful blinking from time to time, and I blink manually when that happens so I kind of disrupt the natural blinking.

The muscle analogy makes sense. I will keep in mind that excessive strong blinking is not good. It’s like a self-induced blepharospasm.

I am glad you could relate. It’s isolating when you think no one else gets you, even here.

2. Lack of sleep is a definite trigger. I once did not sleep enough and then I had to drive to work early next morning so again I did not sleep enough. In my case I need at least 8.75h to 9.5h if I was hiking/skiing etc.

I was in pain for two days. The first day was agonizing. Every blink hurt. All meanwhile we had our strategic retreat at work (so lots of meetings). After sleeping consistently, the pain subsided significantly.

The trouble with my moisture glasses is that they don’t fit perfectly. So they help with fans and wind but are not that helpful with low humidity. I could not find anything that wraps my eyes tightly like goggles. Recently we had really good weather—90% humidity daily. I also keep 60% humidity at home. Whenever I walk in 90% humidity, I almost always feel better.

Do you have the same issue with sleeping? How are you doing by the way?

[Milo007]

Milo007

1. I think like there is truth to your first point. Or at least I hope so. I noticed that when I would remember to blink, I would blink 2-3 times rapidly. I would also make the blinks super pronounced. Again, mainly because I also saw I am a partial blinker (easily seen with a slow motion recording on my phone). Also, I suffer from painful blinking from time to time, and I blink manually when that happens so I kind of disrupt the natural blinking.

There's something more to note here that could be important. You wrote you blink 2-3 times in rapid succession whenever you remember you need to blink.

Well in that case are you sure you are blinking frequently enough?

I mean do you instinctively remember that you need to blink or is it the feeling of dryness that makes you remember you must blink?

You need to practice blinking consciously at a definitive interval (2-3s < your TBUT ideally) with the feeling that your eyelids are touching gently everytime. You could take help of someone else to notice if your eyelids are touching briefly with each blink. Believe me it would feel irritating for the first month and you need to train your eyes to blink every 5s (in your case) with a constant conscious effort. After a month your eyes would adapt to the new blinking pattern and your blink memory would automatically work behind the scenes at a sub conscious level thereafter.

If you are already blinking normally don't be skeptical of it. If you feel paranoid about your blinking pattern and frequency ask someone close to you to record your blinks while you are busy doing some activity (except reading or staring at screens). Unless someone points out that you are not blinking enough trust your eyes and have faith.

Some more questions to make sure you don't have underlying inflammation of your inner eyelid surfaces:

1. Do you feel any burning sensation in the inner surfaces of your eyelids?

2. Do you see any redness in the inner surfaces of your eyelids (both upper and lower separately)?

3. Do you feel any grittiness or occasional irritation arising out of the relative motion of your eyelids and the eyes?

The trouble with my moisture glasses is that they don’t fit perfectly. So they help with fans and wind but are not that helpful with low humidity. I could not find anything that wraps my eyes tightly like goggles. Recently we had really good weather—90% humidity daily. I also keep 60% humidity at home. Whenever I walk in 90% humidity, I almost always feel better.

Have you tried the 7eye RX able sunglasses with memory foam eyecups?

I read some comments in the dry eye zone forum group in Facebook where many were not satisfied with the fit of ziena's glasses but they found the 7eye ones with those foam eyecups providing a better seal. Maybe you could try them once.

You sound similar to me. I feel good in humid conditions (from the point of view of my eyes) often normal but my tear film gets unstable in cold and dry conditions. My lipiview reports below average LLT in both my eyes (right eye better and left eye somewhat marginal). So a low LLT explains tear film instability in low humidity conditions.

Have you done a lipiview to check your LLT and blink sufficiency?

Do you have the same issue with sleeping? How are you doing by the way?

My issues with sleep has been nocturnal lagophthalmos. I discovered a few months ago that I was sleeping with my eyes partially open (right eye opens up more). My right eye was the poorer eye initially. So I have been taping my right eye for the last two months and I have had no inflammation and redness in my right eye since then upon waking up in the morning. Today I visited an optometrist and he pointed out my left eye is having a lower TBUT than my right eye. I can correlate this since for the last 3 weeks I have noticed low volumes of lipids expressing out of my glands in my left lower eyelid (initially meibum yields from the glands of my left lower eyelid was really good). I suspect it to be the result of inflammation since I have been noticing signs of redness in my left eye often upon waking up in the morning and I don't tape my left eye. So I believe my left eye also opens up but not as much as my right eye. I would be taping both my eyes from tonight onwards to see if it makes a difference. Taping my right eye certainly had made a difference since it went from the poorer eye to the better eye according to the optometrist I visited today.

I believe most dry eye patients unconsciously sleep with their eyes partially open and they realize it much later when symptoms of dryness are at their peak. I would also advice you to consider the possibility of sleeping with your eyes partially open since when my eyes used to remain partially open while I slept (before I started taping my eyes) my eyelids would feel painful and sore throughout the day.

In general my eyes have been manageable but I do have some trouble in low humidity conditions. My TBUT went from 3s in July to 6s this month but it fluctuates more than you eiykdwould think. Did IPL (Eyelight IPL and photo biomodulation) on both my eyes this month. Haven't noticed a huge difference though. I am about to order a ziena nereus for me and I hope it would make my eyes more comfortable in low humidity conditions. The fit is the key but can't try them out before purchasing unfortunately.

What about you?