Eye Fluttering and Eyelid Twitching with Topiramate
Yes, eyelid fluttering (myokymia) is a documented neuro-ophthalmologic side effect of topiramate, though it is rarely reported compared to the more common ocular complications like acute angle-closure glaucoma and myopic shift.
Evidence for Eyelid Myokymia
- A case report documented persistent unilateral lower eyelid twitching in a 47-year-old woman taking topiramate for binge eating disorder, which progressed to involve the upper eyelid and eyebrow on the same side 1
- The eyelid myokymia was long-standing and did not resolve with lifestyle modifications or increased rest, but completely resolved after discontinuation of topiramate 1
- Neuroimaging and comprehensive clinical/laboratory evaluations revealed no other cause for the eyelid twitching, confirming topiramate as the causative agent 1
- Ocular dystonias and eye movement disorders can occur with topiramate, though they are less commonly recognized than other side effects 2
More Common Ocular Side Effects to Monitor
While eyelid fluttering is possible, you should be more vigilant for these serious topiramate-related ocular complications:
- Acute angle-closure glaucoma typically presents bilaterally within the first 2 weeks to 1 month of therapy and requires urgent discontinuation and emergent ophthalmology referral 3
- Myopic shift occurs gradually, with mean refractive error changing from -0.23 diopters at baseline to -0.61 diopters at 90 days 4
- Central corneal thickness increases progressively from 531.43 μm at baseline to 537.51 μm at 90 days 4
- Visual field defects and maculopathy have been reported, with maculopathy potentially being irreversible even after drug discontinuation 5
Clinical Management Approach
- If a patient develops persistent eyelid twitching on topiramate that causes distress and does not resolve with conservative measures, discontinuation of topiramate should be considered 1
- Although eyelid myokymia is benign and self-limited, chronic cases can become a significant source of patient distress 1
- Before attributing eyelid twitching to topiramate, rule out excessive caffeine or alcohol use, sleep deprivation, and neurologic causes 1
- All patients on topiramate should be counseled about serious ocular side effects including acute angle-closure glaucoma, which requires immediate medical attention if they develop eye pain, blurred vision, or halos around lights 3, 2