Eye Twitching After Lyme Disease: Facial Nerve Symptoms
Lyme disease can affect the facial nerve
Eye twitching, tearing, weakness, and facial tightness may persist
Residual symptoms may reflect synkinesis or nerve dysfunction
Eye twitching after Lyme disease may occur when facial nerve inflammation or Lyme facial palsy leaves behind residual nerve dysfunction. Patients may describe eyelid twitching, tearing, facial tightness, dry eye, jaw discomfort, or lingering weakness after treatment.
Facial Nerve Dysfunction After Lyme Disease
In their study, Wormser and colleagues found that 6 of the 11 Lyme disease patients, or 54.5%, suffered from facial nerve dysfunction an average of 13.1 months following the onset of treatment with corticosteroids.1
The reported symptoms included tearing while eating, residual weakness, dry eye, narrowed eyelid opening, facial tightness, twitching between the eyes, jaw discomfort with eating, difficulty whistling, and abnormal facial sensations.
- A 52-year-old man had “tearing of left eye when eating (Bogorad’s syndrome); mild residual weakness left side.”
- A 51-year-old man had “mild residual left sided weakness; dryness left eye; after speaking a lot, left sided facial muscles feel abnormal.”
- A 56-year-old man had “narrowed palpebral fissure right eye; dry mouth; sensation of muscles around right eye being squeezed; tearing of right eye; twitching of the area between the eyes on the forehead; new dimple right cheek; intermittent lisp.”
- A 25-year-old man had “narrowed palpebral fissure left eye; reduced forehead movement; right sided jaw discomfort with eating; tearing of the left eye when eating (Bogorad’s syndrome).”
- A 61-year-old man had “narrowed palpebral fissure right eye; difficulty whistling; right eye discharge at night.”
- A 70-year-old woman had “surgical facial nerve decompression nearly 3 months after onset of the LDFP (Lyme disease facial palsy).”
Can Lyme Disease Cause Eye Twitching?
Lyme disease may cause eye twitching when the facial nerve or nearby neuromuscular pathways remain irritated after facial palsy or neuroborreliosis.
Eye twitching, facial pulling, tearing, or tightness may reflect nerve recovery, residual weakness, or abnormal nerve regrowth rather than a primary eye disorder.
Facial Synkinesis After Lyme Facial Palsy
“Facial synkinesis presents following injury to the facial nerve and manifests as involuntary movement during volitional or spontaneous movement,” wrote Shokri and colleagues.2
This phenomenon may become clinically apparent 3 to 4 months after facial nerve injury.2
In Lyme disease, synkinesis may help explain symptoms such as tearing while eating, eye twitching, facial pulling, eyelid narrowing, or abnormal facial movement during speaking or chewing.
Hemifacial Spasm and Lyme Disease
LeWitt described a case of hemifacial spasm from Lyme disease and concluded that “Because its diagnosis can be occult and antibiotic therapy can be both diagnostic and therapeutic, Lyme disease should be a consideration for cases of HFS.”3
This matters because eye twitching or facial spasms may be mistaken for stress, benign twitching, or a primary movement disorder when Lyme disease has affected the facial nerve.
Before and After Lyme Disease Facial Palsy
Some patients notice persistent facial asymmetry, eyelid narrowing, twitching, tearing, or tightness after Lyme facial palsy improves.
Residual symptoms may reflect incomplete nerve recovery, facial synkinesis, or altered facial muscle activation following inflammation of the facial nerve.
In many patients, symptoms gradually stabilize over time, although mild asymmetry or twitching may persist.
Is Facial Palsy From Lyme Disease Permanent?
Facial palsy from Lyme disease often improves with treatment, but some patients report lingering symptoms.
These may include mild weakness, eyelid changes, tearing, twitching, dry eye, facial tightness, or synkinesis.
Persistent symptoms do not always mean active infection remains. They may reflect residual nerve injury, synkinesis, incomplete recovery, or altered nerve signaling after inflammation.
Screening for Lyme Disease in Facial Palsy
Ramsey and colleagues examined acute peripheral facial palsy in Lyme disease patients and found that “10% of patients with APFP testing positive for Lyme disease may be an underestimate, since several other studies in endemic areas have reported rates varying from 14.7% to 33%.”4
The authors recommended screening patients with acute peripheral facial palsy for associated and treatable factors, especially Lyme disease in regions where the disease is endemic.4
Frequently Asked Questions
Can Lyme disease cause eye twitching?
Yes. Eye twitching after Lyme disease may occur when the facial nerve or related neuromuscular pathways remain irritated after facial palsy, inflammation, or nerve recovery.
Can Lyme disease cause facial nerve palsy?
Yes. Lyme disease can cause facial nerve palsy, sometimes called Lyme facial palsy. It may involve one or both sides of the face and may occur with other neurologic symptoms.
Is facial palsy from Lyme disease permanent?
Facial palsy from Lyme disease often improves, but some patients experience lingering symptoms such as mild weakness, twitching, tearing, dry eye, facial tightness, or synkinesis.
What is facial synkinesis after Lyme disease?
Facial synkinesis refers to involuntary facial movement that can appear after facial nerve injury. In Lyme disease, this may cause eye twitching, tearing while eating, facial pulling, or abnormal movement during speaking or chewing.
Can Lyme disease cause facial numbness or muscle twitching?
Some patients report facial numbness, muscle twitching, abnormal sensations, or tightness after Lyme disease. These symptoms may reflect nerve irritation, inflammation, or residual neurologic dysfunction.
Clinical Takeaway
Eye twitching after Lyme disease may be part of a broader facial nerve dysfunction pattern, especially in patients with a history of Lyme facial palsy.
Residual symptoms may include tearing, facial tightness, eyelid narrowing, dry eye, twitching, or mild weakness.
Recognizing facial nerve dysfunction after Lyme disease can help explain persistent eye twitching and facial symptoms while guiding more thoughtful neurologic evaluation.
Related Articles
These related articles explore Lyme facial palsy, neurologic Lyme disease, facial symptoms, and persistent neurologic dysfunction after infection.
Patient With Facial Palsy From Lyme Disease Fails Treatment
Can Bell’s Palsy Lead to Nonflaccid Facial Palsy in Lyme Disease?
Treatment Varies for Bell’s Palsy in Children With Lyme Disease
Neurologic Lyme Disease
Lyme Disease Symptoms Guide
References
- Wormser GP, McKenna D, Scavarda C, Karmen C. Outcome of facial palsy from Lyme disease in prospectively followed patients who had received corticosteroids. Diagn Microbiol Infect Dis. 2018;91(4):336-338.
- Shokri T, Azizzadeh B, Ducic Y. Modern Management of Facial Nerve Disorders. Semin Plast Surg. 2020;34(4):277-285.
- LeWitt TM. Hemifacial Spasm From Lyme Disease: Antibiotic Treatment Points to the Cause. Clin Neuropharmacol. 2016;39(6):329-330.
- Ramsey DJ, Haas LP, Tucker SM. Long-term Outcome After Acute Peripheral Facial Palsy. Ophthalmic Plast Reconstr Surg. 2022.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I’ve seen where some doctors believe this could be helped by botox. What say you ?
I had Bell’s palsy, and tongue and jaw spasms, along with burning mouth, tooth, and gum pain. I finally realized I have trigeminal neuralgia. This is about 3 years after getting bitten by a black-legged deer tick, and contracting Lyme disease.
Welcome to the club. I dont know why the left side is more effected then the right, maybe because it’s the weaker side.
We need a cure!
I have tearing in my left biceps, pain in shoulder up to my neck, feels like radiculopathy, left cheek feels like it has cobwebs over it and occasional itchy eyes and itchy feet. The most recent symptom is De Quervains, a very painful condition that effect the thumb of either both hands, also more effected on the left side.
I wish someone could make sense of what it particular this disease is targeting so I can centralize the pain management process. Is it the nerves, the tendons, the root nerves, peripheral, small fiber nerves,
HEEELP!
Have facial nerve damage on face after 9 years of Lyme disease. Have gone to John Hopkins to Dr. Alcott and still live with this terrible desease.