Objectives: Recurrent ocular myokymia (ROM) is a benign but often disruptive neuromuscular condition characterized by spontaneous eyelid contractions. Although reassurance and trigger avoidance are routinely recommended, many patients experience persistent symptoms that affect visual comfort, concentration, and psychological well-being. No unified rehabilitation approach has been proposed despite the recognized role of stress, lifestyle factors, and digital eye strain. This review aims to synthesize available evidence and develop a hypothesis-generating, multimodal rehabilitation framework that integrates neuromuscular, psychophysiological, and ergonomic strategies. Methods: A structured narrative search of PubMed and Scopus (2015–2025) was conducted using terms related to “ocular myokymia,” “neuromuscular retraining,” “biofeedback,” “mindfulness,” and “digital eye strain.” Eligible evidence included randomized controlled trials, controlled studies, observational studies, case reports, and systematic reviews. Studies were thematically grouped into three rehabilitation domains: neuromuscular retraining, psychophysiological modulation, and visual ergonomics. Evidence was categorized as direct to ROM or extrapolated from related facial neuromuscular and stress-linked conditions. Results: Direct ROM literature primarily describes common triggers stress, sleep deprivation, fatigue, caffeine, and prolonged screen exposure and rare secondary causes such as trigeminal schwannoma. Neuromuscular retraining shows benefit in Bell’s palsy and facial synkinesis, offering conceptually relevant but unproven applicability to ROM. Mindfulness-based stress reduction (MBSR) has strong randomized evidence for physiologic stress reduction and may mitigate stress-induced twitching. Visual ergonomics, supported by controlled trials, reduces digital eye strain (DES) and is reinforced by case-control data linking screen exposure to ROM. Botulinum toxin (botox) A demonstrates efficacy in refractory cases based on case reports and extrapolation from hemifacial spasm literature. Discussion: The available evidence supports a multimodal, non-invasive rehabilitation framework that addresses neuromotor control, stress physiology, and digital behaviors. While promising, this model remains hypothesis-generating, and ROM-specific controlled trials are needed to validate effectiveness, establish optimal dosing, and refine clinical guidelines.
