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Inability to open eyes in a PWP is typically caused by 1) apraxia of eyelid opening, 2) blepharospasm, 3)diplopia avoidance, 4) dry eyes/blepharitis. The first two can be treated with BOTOX injections. Diplopia can be minimized with Fresnel prism or translucent occlusion of one spectacle lens; 4 requires artificial tears and lid scrubs. This is unlikely to be caused by ptosis[droopy lids] since PWP are more likely to show lid retraction than ptosis. J WINTERKORN MD