||Andrew G. Lee, MD, Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, TX, Professor of Ophthalmology, Weill Cornell Medicine; Nicole Alexander, Baylor College of Medicine, Class of 2021
||Summary • Symptoms of apraxia of eyelid opening and benign essential blepharospasm (BEB) both present with difficulty opening eyes. However, there are key differences o Blepharospasm: spasm of orbicularis oculi, squeezing, eye lashes are buried o Apraxia of eyelid opening: eyes are passively closed like you are going to sleep -Can use sensory tricks to manually open their eyes (e.g., patient may rub forehead or tap themselves on the cheek) • Treatment of apraxia of eyelid opening and BEB o Botulinum toxin into the pretarsal orbicularis oculi to relieve inhibition of the levator palpebrae superioris • As these are a form of focal palpebral dystonia, both conditions can occur in other dystonias (e.g., Parkinson's Disease, progressive supranuclear palsy) [Transcript of video] "So today we are going to be talking about apraxia of eyelid opening. Apraxia of eyelid opening is sometimes associated with a condition that we already have covered, which is benign essential blepharospasm (BEB). From the prior YouTube video where Misha demonstrated the blepharospasm, today we have a very special guest, Ashley, who is going to show us the blepharospasm. And blepharospasm is bilateral, simultaneous, and squeezing. However, it can be associated with apraxia of eyelid opening. And so, the patients both say the same thing - they're having difficulty opening their eyes. But in blepharospasm, the patients have spasm of the orbicularis that is preventing the eye from opening. And in apraxia of eyelid opening, the eyes are just passively closed. So, it's almost like you're going to sleep or you're asleep, that kind of close. The lashes are not buried. So, in blepharospasm, the eyelashes are buried because the orbicularis is firing, but in apraxia of eyelid opening, it is just slightly closed like they are asleep. And the two conditions are actually related because we have the obvious form of orbicularis related spasm, blepharospasm, but if the pretarsal orbicularis oculi is firing -and as you know the tarsus is in the lid-if the pretarsal orbicularis is firing, then the eye won't open because there is inhibition of the levator. And so, patients with apraxia of eyelid opening say they cannot open their eyes, but if they voluntarily, manually open their eyes, it might open completely. And some patients use some type of sensory trick to get their eye open, so they might rub their forehead like this or tap themselves on the cheeks. Here we go again, apraxia of eyelid opening, the lids are closed. She's going to use the sensory trick now to try to get her eyes open, and miraculously the eyes pop open. And so, interestingly, the treatment of blepharospasm and apraxia of eyelid opening is botulinum toxin. But we normally would inject the botulinum toxin into the pretarsal orbicularis oculi to relieve the inhibition of the levator, and that will allow the eyes the open up. So, apraxia of eyelid opening and benign essential blepharospasm occur in the same patient. It can also occur in other dystonias because this is a form of focal palpebral dystonia. And so, the other dystonias syndromes like Parkinson's Disease and progressive supranuclear palsy might also have apraxia of eyelid opening."