Questions From the Spring 2004 Support Group Meeting
Respondents:
Dr. Martin Kazdan
Dr. Yasser Khan
Dr. Stephen P. Kraft
Questions:
- How are the sights for injections selected?
- What would be the ideal lighting for a sufferer of Blepharospasm (BEB) who wishes to remain in the workforce.
- Some say that "light sensitivity" is a symptom of blepharospasm. What is your opinion, Dr. Kraft?
- Dr. Kazdan was asked if blepharospasm (BEB) was a progressive disease.
- Dr. Khan, what type of tear-medication would you recommend for dry eyes?
Q. – How are the sights for injections selected?
Dr. Kazdan:To begin with they would be centred principally in the area that was involved. For example, for the eyes there are six principal locations or points of injections. The dosage may vary from one per injection site or as high as ten per site: it depends on the need of the individual being treated. The high dosage may be the result of years of treatment and may be required to maintain the desired level of relief.
Q. – What would be the ideal lighting for a sufferer of Blepharospasm (BEB) who wishes to remain in the workforce.
Dr. Kazdan:It must be remembered that the sensitivity to light varies from patient to patient, and, that there is no fixed answer. Each sufferer would have to work that out for him/herself. However, there are some general observations that each BEB sufferer could take into consideration.
Dr. Kazdan went on to emphasize that most treatments vary according to the responses received by the ophthalmologist from the patient. Doctors do not ask questions of the BEB patient in order to effect social pleasantries; but, rather to find out what is new at this stage of the patient's life. For example, what new side effect a patient may be experiencing both from the point-of-view of the malady and past treatment. How long did the last dose of BOTOX® injections last: and, so on. From these responses the doctor can make informed decisions regarding the patient and future treatments.
Q. – Some say that "light sensitivity" is a symptom of blepharospasm. What is your opinion, Dr. Kraft?
Dr. Kraft:In my opinion there are two reasons for the sensitivity to light. The first is that rubbing on your eye changes the dynamic of the tear-film covering the cornea. This change in dynamics will increase the amount of light entering through the pupil: especially in young people who have very large pupils.
Secondly, as one gets older the tear-film viscosity is not the same as before, and, the constant blinking of the eyelid causes the dynamic to change passing light through the pupil which is open due to the prolonged blink: hence, photophobia or light sensitivity. However, it should be noted, that light gets through a closed eyelid in the form of “red” light and, that the older person's pupil is somewhat smaller and not subject to large swings in dilation as seen in a teenager, so the light must be somewhat intense to cause acute photophobia.
All three physicians agreed that sensitivity to light or photophobia may be averted somewhat by getting anti-glare coating added to your glasses and, by getting glasses that automatically darken according to the exposure to light: photo-chromatic lenses. Polarized filters are also a good and a thrifty alternative and, sunglasses should be polarized on a neutral grey or green tint. People without BEB may also suffer from photophobia and use these alternatives to cope with their sensitivity to light.
For outside glare polarized sunglasses are possibly the cheapest alternative to prescription lenses. For indoors the addition of an anti-glare coating to your existing glasses will help one cope with such things as fluorescent lighting. Photo-chromatic lenses are a good bet as well. This self-adjusting lens may assist in bringing to the BEB patient some relief to their sensitivity to light.
Dr. Khan:I recommend to my patients a fairly viscose tear-drop because I realizes that in my more senior patients there is no longer the rapid response toward the intensity of light that they would have had when they were younger and, effected a more pronounced dilation or response to light. This viscose-tear, if you will, coats the cornea and helps decrease the intensity of light. For each BEB sufferer the type of “tear-drop” that is used varies according to their particular need and physiognomy.
Q. – Dr. Kazdan was asked if blepharospasm (BEB) was a progressive disease.
Dr. Kazdan:According to my observations over the years, blepharospasm from its on-set was a progressive disease for some time, perhaps two to three years. However, one thing that I noticed was that, for some unknown reason, some BEB patients appeared to get over the disease for a short period of time.
Dr. Kraft:For many years blepharospasm was unknown and often thought to be a psychogenetic disease. In fact BEB is a neurological disease whose exact origins are unknown or what exactly happens to the brain. Continued research is giving us a better idea of the areas of the brain that may be affected and the chemistry that is abnormal. It has been classified in a group of diseases that are known as dystonia.
There are a large number of people that are affected in various parts of the body just as our members are affected around the eyes. There are musicians who can no longer work because they have not "eye" but "arm" spasms. There are writers who have “writers spasms” and can no longer write. This is generally known as spasmodic dystonia. There are people affected in the lower part of the face and not the upper. Unfortunately, there is a percentage of people who start with the eyelid spasms only to have these spasms progress to other parts of their body: specifically the face and this is called Meige. Meige is simply the unfortunate progression of the disease from the eye area (blepharospasm) to the lower facial muscles which undergo the same spasms and contractions. Some of this may be relieved by BOTOX® injections and /or other specific medication.
These spasms may progress further down the neck and are then called spasmodic torticollis. In this way we say that the disease “progresses.” The eyelid spasms will become pronounced over time but the real “progression” of the disease is that the chemical imbalance that affects the eye-muscles may spread to other muscles in the body simply because those muscles are also controlled by the same part of the brain. A minority of my patients will experience this type of progression. The majority of my patients have BEB only.
Q. – Dr. Khan, what type of tear-medication would you recommend for dry eyes?
Dr. Khan:Often the production of tears is influenced by an autoimmune response on the part of the body. An overDr. Khan felt that the brand of medication that was mentioned was not too effective for severe dry-eyes or blepharitis. I recommended that anyone who has severe dry-eyes and/or blepharitis should first see his/her ophthalmologist and ask for a Schirmer Tear Test to see what the productions of tears is really like and then go from there. Another possibility, he went on to suggest, was tear-plugs.
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