Apraxia of Eyelid Opening: A Cause or Botulinum Failure

Three patients seen over the last two years presented with somewhat atypical episodes of blepharospasm. All were enrolled in ocuiinum therapy of blepharospasm according to the protocol of Dr. Alien Scott. Periocular Injection resulted In severe diminution or complete abolition of orbicularis strength. In spite of this all three patients demonstrated episodes of inability to initiate eyelid opening. Once the eyelids were opened, however, (opened utilizing their fingers) there was no evidence of ptosis. Two of the patients were originally diagnosed as having Parkinson's but on Neuro-ophthalmlc evaluation were felt more likely to represent forms of progressive supranuclear palsy.