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An Osteopathic Approach to Eyelid Myokymia

Journal: The AAO Journal Date: 2024/06, 34(2):Pages: 23. doi: Subito , type of study: case report

Full text    (https://meridian.allenpress.com/aaoj/article/34/2/16/500954/LBORC-NUFA-Poster-Abstracts-2024-Students)

Keywords:

case report [708]
eyelid [1]
female [597]
myokymia [2]
OMT [3750]
osteopathic manipulative treatment [3770]
twitching [2]
women [553]

Abstract:

Introduction/Background: Eyelid myokymia (EMKM) are spontaneous, constant contractions spreading through striated muscle, most commonly orbicularis oculi unilaterally. EMKM typically lasts days to weeks, has unknown etiology, and is precipitated by stress, fatigue, or inadequate sleep. Botulinum toxin injections or surgery can improve symptoms. This case demonstrates the effectiveness of non-invasive osteopathic manipulative treatment (OMT) for EMKM. Case: 51-year-old female presented to OMT clinic with hourly right EMKM for 2 months. Episodes lasted seconds and affected her ability to maintain eye contact while talking. Optometry ruled out vision changes and other abnormalities, and she did not improve with lubricant eye drops. Intraoral techniques and Osteopathic Cranial Manipulative medicine reduced hypertonic bilateral masseters, pterygoids, sphenopalatine ganglion tension, lymphatic congestion and cranial somatic dysfunctions. Results: The patient received 8 OMT sessions over 13 weeks, decreasing EMKM episodes from hourly to weekly. Baseline scores included 6/4 in the Blepharospasm Disability Index (BDI), 4/4 in severity and frequency in the Jankovic Rating Scale (JRS), and 30% in the Neck Disability Index (NDI). At the last visit, improvement in function and activities of daily living were seen: JDI 0/24, JRS 2/4 severity and 3/4 frequency, and 18% NDI. Discussion: Though overlooked by physicians as benign and self-limited, EMKM can be disturbing when persistent and recurrent. OMT offers non-invasive treatment that decreases frequency and improves quality of life. Stimulating the pterygopalatine ganglion by inducing lacrimation and releasing facial muscle tension may affect parasympathetics and improve EMKM. Limitations of this case include potential confounding variables, such as the patient’s use of eye drops and stress levels. Further research can substantiate the efficacy of OMT in EMKM treatment.


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