A Man With Unilateral Eyelid Twitching

C. Robert Bernardino, MD


April 03, 2013

Clinical Presentation

A 60-year-old black man presents with a 1-month history of progressive right-sided eyelid twitching. He reports that the twitching has progressed and now involves his midface and corner of his mouth. He denies any pain or headache. He has experienced no vision changes or photophobia. He also complains of tearing from the right eye.

On examination, the patient's best corrected visual acuity is 20/25 bilaterally. His pupils react normally, with no afferent defect. His visual field is full to confrontation in both eyes, and he has full ocular motility. His anterior segment is unremarkable, and a fundus examination is normal.

An external examination reveals twitching of the right upper and lower eyelids. Forced closing of the eyes by squeezing induces twitching that spreads to the patient's midface and right lip. The patient's orbicularis function is normal and symmetric on both sides.

The video below of the patient demonstrates twitching of the right side of the face.

This feature requires the newest version of Flash. You can download it here.