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Ask the Doctor 2013 Number 3 (May/June)

Disclaimer: neither the BEBRF nor members of the BEBRF Medical Advisory Board has examined these patients and are not responsible for any treatment.

Q: I have had blepharospasm for a number of years. I take botulinum toxin injections and I had myectomy surgery. As a result, I have extremely dry eyes and have been using a lot of drops. I found a nutritional supplement called Doctor's Best Glucosamine Chondroitin MSM Plus HA 150C. It seems to have helped my dry eye, but it looks like it is intended for joint problems. Do you have any idea why it would be helpful for dry eye?

A: It may sometimes help joint problems in the right format and dose. Equivocal benefit for arthritis from several studies in humans, but lots of people take it. I believe the original rat study showed some benefit in damaged cartilage repair. There is no rationale whatsoever for treatment of dry eyes. It may be a placebo effect like some with joint issues get.

James R. Patrinely MD FACS, Plastic Eye Surgery Associates, Pensacola, Florida

Q: I have BEB and suffer from severe dry eye. A friend sent an article about a product made in England called Blephasteam goggles. They are plugged into to an electrical outlet and they produce moisture around the eyes. I thought Blephasteam might help my condition but discovered that it is not available in North America. I thought of having my friend purchase it and mail it to m. The cost is significant and I read on one website that medical advice should be sought before using blephasteam. I wonder if the ophthalmological experts on your team have opinions on the use of this product for blepharospasm.

A: I am sorry, but I have no experience with this product. The concept is based upon the principles that moist heat penetrates the eyelid better than dry heat and that warming the meibomian glands tends to melt inspissated (thickened) oils, facilitating flow into the tear film. This is desirable, and many patients with blepharospasm find warm compresses on their eyes to be very helpful. Our patients typically put 2-3 cups of raw rice in an 80% cotton tube-sock tied off with a string and micro waved for about a minute, then placed in a plastic bag over a hot, wet facecloth to be effective. (Some patients like to add lavender leaves). The question is whether this steam product's presumed increased consistency and ease of use justifies the cost of the device and its "replacement rings" (neither of which are posted on their website). Finally, it sounds as though the device must remain plugged in during use, whereas a heated sock may be carried anywhere. Assuming the device is not prohibitively expensive, easily transported, and not a source of growing contaminants, I like the idea and would be interested to hear peoples' experiences.

Charles N.S. Soparkar, MD, PhD, Plastic Eye Surgery Associates, Houston, Texas

Q: Have any topical medications been studied to treat blepharospasm, including medications that have been suggested for use orally such as Baclofen? Could this be helpful for patients who are having break-through spasms between BOTOX® injections, or who find that BOTOX® isn't working for them, without the oral systemic side-effects? Are there any dangers of using such medications near the eyes or on the face?

A: At present, there are no topical agents clinically available for blepharospasm. At the National Institutes of Health (NIH), there are some ongoing clinical trials of a topical agent, but this is entirely an experimental enterprise. It is not clear what the eventual clinical role of such an agent will be.

Mark Hallett, MD, NINDS, NIH, Bethesda, Maryland

Q: I have had blepharospasm since 1979 and have had myectomy surgery twice. I have also used BOTOX® since 1984. Now I am experiencing trouble talking. My voice used to be soft and some said sexy. It has gotten gravely and sounds terrible. My throat aches at times. Could this be caused by blepharospasm?

A: Many, if not most patients with blepharospasm, have some trouble with talking, usually because of involvement of their mouth, jaw, tongue and even vocal cords by dystonia, the same condition that causes blepharospasm. Dystonia may not only cause spasm of eyelids resulting in eye closure (blepharospasm) but may cause spasm of the lower part of the face, neck, and throat. Dystonia of the vocal cords is also called "spasmodic dysphonia." Botulinum toxin injections often relieve not only blepharospasm but also mouth and jaw dystonia (oromandibular dystonia) and spasmodic dysphonia. A movement disorder neurologist or a qualified otolaryngologist can sort out what causes your speech difficulty and, hopefully, can restore your "sexy voice."

Joseph Jankovic, MD, Director, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas


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