Wink Wink, Nudge Nudge 

For the last three weeks, my right eye has been twitching a half-dozen times a day. Ordinarily it wouldn't bother me, but these twitches happen in the muscle directly adjacent to the side of my eye. Therefore it shakes my eyeball and interferes with my vision. Not only is it really annoying, but it makes conversations with my co-workers awkward because it looks like I'm winking at them. I'm getting so tired of apologizing for it. Help me, Dr. Rabin, please.

—bonderic72

I can certainly appreciate a mistaken flirtation. In fact, the consequences of such an incident should be immediately familiar to anyone who has watched a situation comedy in the last four decades. The inadvertent wink scenario seems to be nearly as common as the routine involving a circulating unsigned love note. These were both tired bits when Mr. Roper and Alex P. Keaton did them, and I doubt they were any fresher with George Costanza than with George Jefferson. But the one important lesson we can learn from the sitcom versions of your problem is: Never, ever, take advice from your wacky neighbor.

Even less amusing than, say, The King of Queens, is the extreme extent to which some people suffer from eye twitches. Your own description, in contrast, suggests the most benign of twitches called fasciculations. These are defined as rhythmic, involuntary muscle contractions that are generally visible under the skin. Fasciculations are common to facial muscles, but they can occur in any skeletal muscle like those in the upper arms or chest. At the opposite, most severe end of the twitch scale is blepharospasm, a neurological disorder that can manifest as involuntary blinking or a relentless, repetitive spasm in the eyelid or surrounding muscles—a condition that makes your wiggly eyeball seem like a walk in the park by comparison.

Blepharospasm is classified as a movement disorder, and like its cousins, Parkinson's and Tourette's, it is exacerbated by stress. Fatigue, lack of sleep and dry eyes can all aggravate the condition. An unusual trigger for many is bright light, such as direct sunlight or fluorescent bulbs—even looking at a sheet of white paper can stimulate an attack. Blepharospasm may be so severe that it can lead to functional blindness from an inability to keep your eyes open. Not much potential for sitcom hilarity there, but this particular script does have a happy ending featuring a cameo appearance by the crowd-pleaser, Botox.

Since drug therapy is effective in less than 20 percent of cases and invasive eye surgery is fairly unpleasant, Botox has emerged as the treatment of choice for blepharospasm. This muscle-paralyzing neurotoxin secreted by the Clostridium bacteria is no longer just for dispatching useless husbands and unsightly wrinkles. A few well-placed injections can relieve blepharospasm in most patients for three to four months, sometimes longer. An infrequent side effect of this treatment, however, is a temporary drooping of the eyelids called ptosis. Temporary, one certainly hopes, else you're left resembling Harry, the squinty-eyed annoyance from 3rd Rock from the Sun.

For the comparatively mild fasciculations you describe, the first step should be to consider adding more magnesium to your diet; most Americans are lacking in this essential mineral. In addition to low intake, mild dehydration (also quite common) will reduce the body's stores of magnesium even further. The lack of it, or an improper calcium/magnesium balance, is directly responsible for the wiggly muscle fasciculations. Additionally, the mineral is known to encourage good quality sleep, another factor that may help you ditch the twitch. Because magnesium is part of the chlorophyll molecule, good natural sources include spinach and other green leafy vegetables, but peanuts and bananas are also excellent sources.

Next in importance is stress reduction, with my oft-repeated suggestions of meditation, increased physical activity and reduced caffeine intake. If light seems to bring on the eyeball shimmy, try decreasing the contrast and brightness of your computer screen. Drinking tonic water, which contains quinine, might also help. Quinine, responsible for the slightly bitter taste of tonic, has long been known to be an effective muscle relaxant. Finally, if nothing else seems to help, gentle massage of the muscles surrounding the eye has been reported to help many avoid an expensive trip to the Botox doc.

So in review, what have we got? Gin and tonics, peanut butter and banana sandwiches, facial massages and soft relaxing music—all of which could be neatly arranged in your office cubicle. As a practical solution to inadvertent co-worker flirtation, the list has a number of significant drawbacks. But as a jumping off point for a comical story line, this is a plan worthy of Kramer.

Dr. Ed Rabin is a chiropractor practicing at Life Chiropractic Center in Boise. Send autographed photos of French Stewart and health-related questions to theantidote@edrabin.com (on the Web at www.edrabin.com).

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