Apraxia of eyelid opening: clinical features and therapy.
OBJECTIVE
Botulinum toxin injection is the treatment of choice in cases of benign essential blepharospasm. However, about 10% of the patients do not get sufficient effect from this treatment, and many of them have concomitant apraxia of lid opening.


METHODS
Over a 3-year period we treated 12 patients. Three had pure apraxia of lid opening and in the other nine it was associated with blepharospasm. All patients were initially treated with botulinum toxin injections with poor results. They underwent surgical treatment like blepharoplasty, limited myectomy, aponeurosis repair, and/or frontalis suspension. Some of them needed post operative botulinum toxin injections in the pretarsal part of orbicularis oculi muscles.


RESULTS
This combined therapy gave good functional and aesthetic results.


CONCLUSIONS
The specific causes of blepharospasm and apraxia of lid opening are unknown, but these two conditions coexist in some patients and can be difficult to treat. It is important to make a correct diagnosis, and a combined surgical and botulinum toxin treatment can be very effective.
Kerty
E
E
Department of Neurology, Rikshospitalet, University Hospital, Oslo, Norway. kerty@klinmed.uio.no
Eidal
K
K
D000368:Aged; D001072:Apraxias / Q000175:diagnosis* / Q000628:therapy*; D019882:Blepharoplasty; D001764:Blepharospasm / Q000175:diagnosis* / Q000628:therapy*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005143:Eyelids / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use; D009801:Oculomotor Muscles / Q000601:surgery
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A