A 33-year-old otherwise healthy male presented with a week-long history of isolated right lower eyelid myokymia. Two weeks later, the patient’s myokymia had progressed to include twitching of the right brow and right upper lip. Imaging revealed multiple demyelinating lesions consistent with multiple sclerosis. A review of eyelid and facial myokymia, along with possible concerning causes is provided, geared towards the oculoplastic surgeon. Eyelid myokymia, typically a benign condition, may rarely evolve into facial myokymia reflective of underlying brainstem disease.