Cogan's lid twitch and eyelid hopping

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Cogan's lid twitch sign, characteristic of myasthenia gravis, consists of a brief overshoot twitch of lid retraction following sudden return of the eyes to primary position after a period of downgaze.(1-3) The lid will briefly twitch upwards then settle back to its previous position. (Video) This sign should increase suspicion of MG but is not diagnostic; it may be seen in other conditions. A similar upward twitch may occur on glancing quickly to the side from primary position (eyelid hopping).

In a series of 117 patients, the specificity of the lid twitch sign was 99%, the sensitivity was 75% and the false-positive rate was 1%.(4)


1. Campbell WW. Clinical signs in neurology : a compendium. Philadelphia: Wolters Kluwer Health, 2016.

2. Campbell WW. DeJong's the neurologic examination, 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013.

3. Cogan DG. Myasthenia gravis: a review of the disease and a description of lid twitch as a characteristic sign. Arch Ophthalmol. 1965 Aug;74:217-21.

4. Singman EL, Matta NS, Silbert DI. Use of the Cogan lid twitch to identify myasthenia gravis. J Neuroophthalmol. 2011 Sep;31(3):239-40.