Eye Opening Problems
If you have difficulty keeping your eyes open, it may be one of two causes: Eye Opening Apraxia or Blepharospasm.
Eye opening apraxia is a difficulty in opening eye lids after closure. With this problem the nerve signal from the brain instructing your eyelid muscle called the orbicularis oculi (see picture to right) to open is disrupted. Your eye lids are closed and have difficulty 'opening on command'. Spontaneous blinking and eye muscle strength is normal and once eyes are opened they can stay open. Bright lights and stress can worsen the problem.
Eyes are not actively closing or 'squeezing shut' as is the case in bleharospasm (although both conditions can co-exist). When trying to open eye, a person may use the forehead muscles or throw their head backward.
It is more common in forms of atypical parkinsonism such as Progressive Nuclear Palsy, stroke and less commonly seen in PD. STN DBS stimulation
can sometimes cause eye opening apraxia.
is more commonly seen in PD (as a complication of medical therapy) and is a closure of eye lids due to involuntary contraction of the eye lid and adjacent muscles. Unlike eye opening apraxia, it is difficult to keep eyes open due to a forceful closure of the eyes. Muscles of the forehead, nose and middle cheek can also be affected. This condition is most a form of dyskinesia or uncontrollable movement caused by medicines, namely long-term use of levodopa. Blepharospasm can also be associated with dystonia of the face and jaw.
Both conditions can lead to falls and trouble seeing. The following treatments can be helpful:
- Medication change. Ask your doctor to review your Parkinson's medicines if you are experiencing dyskinesia or blepharospasm.
- DBS can help blepharospasm if it is thought to be a symptom of dyskinesia.
- Botulinum toxin injection into the eye muscles can help both conditions.
- Dark glasses can reduce problems from excessive light stimulus.
- Occupational therapy can work with you to keep you safe from falls and injury.
Authors: Monique Giroux, MD
Copyright 2011 Northwest Parkinson's Foundation Wellness Center