Facial and eyelid twitching

Hello.  About 2 months ago I had conjunctivitis in my left eye for about a week.   After it cleared up I noticed twitching in that same eye off and on for 3-4 weeks.  Then about a week ago, my right eye twitched off and on.  I saw my doctor who indicated that my cranial exam was normal and it could be due to an electrolyte imbalance, so I started taking magnesium and drinking more Gatorade.  I noticed that is happens less frequently when I do this, however today the left side of my face close to my left eye has twitched a few times.  It is definitely not continuous and doesn't seem to happen when I'm not thinking about it, i.e. when I exercise (6x/week) I don't feel it at all.  I have a stressful job and don't always sleep very well, but other than a bit more stress lately this hasn't changed much.  One other symptoms is a small amount of blood in my right nostril off and on, only when i blow my nose and more indicitive of a dry nose vs. continuous bleeding (perhaps from the magnesium or occasional OTC sleeping pill I take)?

When should I go back for another doctor visit?  Should I be concerned?

Thanks!

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Twitches in the majority of cases are benign meaning they have no consequence and do not cause serious damage or are resulting from serious damage. The twitches can occur focally (one location) or generalized (many locations). Twitches can be related to anxiety/stress, caffeine, and often occur post exercise or muscular over-use.

There is another condition called hemifacial spasm. This is a spasm of the muscles around the eye which may gradually spread to other muscles on the face or neck. It may be aggravated or induced by action or reflexive facial movements. It is not known what exactly causes this condition but it is believed that is due to demyelination of the seventh cranial nerve likely from nerve root compression. The treatment for this condition involves medical therapy with carbamazepine. If this medication fails, baclofen or gabapentin can sometimes be useful. If intolerant to these medications or failure to these medications, botulinum toxin has been used. Failing these conservative measures, surgery is quite appropriate.

I suggest you continue to follow up with your primary physician regarding your facial twitching.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.