Myokymia is strongly associated with stress, fatigue, and/ or high caffeine intake – factors that often coexist. The muscles of the eyelid are controlled by delicate nerve signals, and stress and caffeine can make these nerves more excitable. Once triggered, the twitching can last for hours or even days. However, it usually comes and goes. For people under sustained stress, persistent twitching can become a source of anxiety. Ironically, this may make the twitching worse. Conversely, the twitching typically resolves with adequate rest, reduction in caffeine consumption, and stress management.

It is important to distinguish myokymia from rarer neurological conditions, such as blepharospasm, where there is involuntary and forceful closing of both eyes at the same time; or a hemifacial spasm, where there is twitching and pulling of the muscles on one side of the face. A consultation with your ophthalmologist can help distinguish between these conditions and guide the appropriate treatment.

Central Serous Chorioretinopathy

Fundus image of the retina used to detect early signs of eye disease and vision disorders.

One condition that deserves special mention when discussing stress and eye health is central serous chorioretinopathy, often abbreviated as CSCR. This is an eye condition that affects the retina, which is the light-sensitive layer at the back of the eye. Patients with CSCR may describe blurry vision. Some may notice a dark or yellow patch in the centre of their vision. There may also be visual distortion, where straight lines appear wavy, or objects look smaller than they should be.

The underlying problem in CSCR involves blood circulation beneath the retina, where there is leakage of fluid from the blood vessels. This fluid pools under the centre of the retina, disrupting the retinal cells and resulting in visual symptoms. In many cases, the fluid resolves within 3–6 months without treatment. Vision usually recovers as well. In rare situations where the vision is very poor, or fluid remains beyond 3-6 months, then laser treatment or photodynamic therapy (PDT) may be advised.

Stress and CSCR

CSCR is relatively uncommon but has long been associated with stress and elevated stress hormones, in particular cortisol. It seems to occur more often in individuals with so-called “Type A” personalities, or in people experiencing significant emotional or occupational stress. Researchers have also linked steroids to CSCR. These include tablets, skin ointments, and nasal sprays. Diseases that increase steroid hormone production in the body may also contribute.

Anyone who experiences a sudden change in eyesight should get their eyes checked as soon as possible. Symptoms may include blurred vision, patches in vision, or visual distortion. While CSCR is one possible cause, other diseases such as a retinal detachment or age-related macular degeneration can also present with similar symptoms and require much more urgent treatment.

Migraine visual aura with zigzag patterns, a common symptom affecting vision before a headache.

Migraines

Migraines are common and sometimes misunderstood to be just a “bad headache.” In reality, migraines are a neurological condition. They may present as intense throbbing or pulsating pain on one side of the head, often accompanied by nausea, vomiting, and sensitivity to light and sound. The pain can last anywhere from four hours to even three days! Stress is one of the most common triggers for migraines. Emotional tension, disrupted sleep, skipped meals, and hormonal changes can all increase the likelihood of an attack.

Visual Auras and Migraine Symptoms

I often see patients with migraines because they may have experienced visual disturbances before an attack. These are known as visual auras, and may include shimmering or zigzagging lights, flashing patterns, or temporary loss of part of their vision. The symptoms usually affect both eyes. They can last from 15–60 minutes before resolving on their own. Typically, these visual auras occur before the headache occurs and can serve as an early warning to migraine sufferers of an impending attack. Auras can also take the form of tinnitus (ringing in the ears) or even temporary numbness, weakness or tingling in the arms and legs. Not everyone with migraines experience auras, and auras may also not occur in every episode of a migraine.

Managing Migraine Symptoms

Visual auras can be alarming, especially when they occur for the first time, or if they become more frequent. Many people worry that they are developing a serious eye disease, or even a stroke! It is wise to seek an eye evaluation for new or unusual visual symptoms. However, doctors usually believe migraine-related visual disturbances result from temporary disruptions in brain activity rather than problems within the eye itself. Effective management usually involves identifying triggers, addressing lifestyle factors, and, when needed, medical treatment under the guidance of a family physician or neurologist.

Conclusion

These conditions highlight the many ways that stress can show up in the eyes. Some are subtle and merely a nuisance, others are more dramatic with actual changes in vision, yet they all demonstrate the interplay between the mind, body, and vision. Recognising physical and emotional stress as contributing factors allows for a more holistic approach to eye health. This includes medical care, attention to sleep, emotional well-being, and better work-life balance.