Does chronic video gaming contribute to blepharism (involuntary eyelid twitching)?

Does Chronic Video Gaming Contribute to Eyelid Twitching (Blepharospasm)?

Yes, chronic video gaming and prolonged digital screen use are strongly associated with eyelid twitching (myokymia), primarily through mechanisms of reduced blink rate, eye strain, and ocular surface disruption.

Direct Evidence Linking Screen Time to Eyelid Twitching

The most compelling evidence comes from a 2024 study demonstrating that patients with eyelid myokymia spent significantly more time on digital screens (6.88±2.01 hours) compared to controls (4.84±1.74 hours), with a strong positive correlation (r=0.670) between duration of eyelid twitching and screen time 1. This represents the highest quality recent evidence directly addressing your question.

Mechanisms of Screen-Related Eyelid Dysfunction

Reduced Blink Rate and Incomplete Blinking

• Prolonged computer gaming for 4 hours significantly decreases blink rate and blink completeness, leading to ocular surface disruption 2
• Increased screen time reduces blink rate and exacerbates dry eye and ocular surface disease in both adults and children 3
• Incomplete blinking is associated with a two-fold increase in evaporative dry eye with meibomian gland dysfunction 3

Accommodative and Vergence Stress

• Continuous gaming for 4 hours causes convergence and accommodation disturbances, with decreased accommodative and vergence facilities 2
• Children playing video games ≥30 minutes daily show significantly higher rates of asthenopia, including eyelid tic, headache, transient diplopia, and dizziness 4

Ocular Surface Inflammation

• Digital screen use leads to blepharitis and meibomian gland dysfunction through reduced blinking and increased tear film evaporation 3
• Neuromuscular disorders affecting blinking (including fatigue-induced dysfunction) are associated with eyelid conditions and dry eye 3

Clinical Distinction: Myokymia vs. Blepharospasm

Important caveat: The term "blepharism" appears to be a misspelling. If you mean:

• Myokymia (benign eyelid twitching): This is what screen time causes 1
• Blepharospasm (involuntary forceful eyelid closure): This is a neurological movement disorder not caused by screen time 5

The evidence supports screen-related myokymia, not true blepharospasm.

What the Evidence Does NOT Support

The 2024 study found no association between eyelid twitching and uncorrected refractive error, intraocular pressure, or blood electrolyte imbalances 1. This is clinically important as it narrows the differential diagnosis.

Management Approach

Immediate Interventions

• Reduce daily screen time to <5 hours, as this is the threshold where risk increases 1
• Implement the 20-20-20 rule: Every 20 minutes, look 20 feet away for 20 seconds to reduce accommodative stress 2, 6
• Conscious blinking exercises during screen use 7

Eyelid Hygiene (if concurrent blepharitis)

• Warm compresses for several minutes once or twice daily 3, 8
• Gentle eyelid massage to express meibomian glands 3, 8
• Eyelid cleansing with diluted baby shampoo or hypochlorous acid 0.01% cleaners 3

Ocular Surface Support

• Artificial tears for symptomatic relief 8, 6
• Address underlying dry eye if present 3, 7

Key Clinical Pitfalls

• Do not dismiss eyelid twitching in heavy screen users as purely stress-related—there is objective ocular surface pathology 1, 2
• Visual functions typically recover by the following morning after cessation of gaming, but chronic exposure leads to persistent symptoms 2
• Children are particularly vulnerable, showing higher rates of asthenopic symptoms including eyelid tics with ≥30 minutes daily gaming 4
• Screen-related symptoms are typically worse at end of day, distinguishing them from blepharitis (worse in morning) 3, 8