 |
 |
William Hampton <[log in to unmask]> My Wife Doris has had PDplus for approx eight years now. In the last several months she has had periods when she cannot open her eyes. The lids just refuse to open. I am just wondering if any of the folks on this list have ever had this problem and if so what were they able to do about it..Any help with this would be appreciated. Bill: The degree of difficulty you describe in the absence of ocular pain or redness, is likely to represent Essential Blepharospasm. Blepharospasm is part of a progressive dystonia involving the lower face as well as the eyes. Both Essential Blepharospasm and Apraxia of eyelid opening have been associated with PD and PSP. These movement disorders also occur in patients who do not have PD --frontal lobe activity may be abnormal. Essential Blepharopasm is often mistaken for reflex blepharospasm [e.g.the kind of tight eye closure we all get from a cinder in the eye] and it goes undiagnosed and untreated for a long, uncomfortable time during which the patient is told to use artificial tears - or antidepressants - neither of which provide relief in this syndrome. [Indeed, patients with PD also can have dry eyes, but that is unrelated to blepharospasm or apraxia, which are movement disorders!] Some patients develop "sensory tricks," such as singing or whistling to keep the eyes open when driving. The treatment of choice -- after a careful diagnostic neuro-ophthalmic exam to rule out local ocular or cranial nerve (V and VII) dysfunction -- is periodic injecttion of Oculinum [Botox or botulinum toxin]. This is a simple office procedure with miraculous results--my patients return every 3 to 5 months. Ask your neurologist specializing in movement disorders or the Blepharospasm Society or me for referral to treatment wherever you live. JMSWinterkorn, MD