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Ask the Doctor 2014 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 blepharospasm and Meige, and my right eye over-tears constantly. This is since I had punctal plugs put in for dry eye before they diagnosed my problem as blepharospasm. The plugs worked their way out but left scar tissue in the tear duct in the right eye, which is now totally blocked so no tears can escape through the duct to my nose. I have had two tear duct surgeries and neither have been successful at opening the duct for proper drainage. I am wondering if I would be a candidate for a contact in that eye for reading, since I understand that contacts dry out your eyes. I wear corrective vision glasses, and my left eye is dominant, and my right eye is the one that over-tears. I would like to know if that could be an option or would that not be a good idea due to my condition?

A 1: Tear overflow is a difficult problem to deal with and I am sorry that you are suffering from this. The good news is that there are surgical solutions, but the key is understanding the anatomic problem that is causing the tearing. Punctal plugs may cause tearing due to scarring when they are placed deep within the tear duct system. Contact lenses will not correct this problem. I would recommend that you see an oculoplastic surgeon who understands the lacrimal (tear duct) system for proper evaluation and treatment. A good place to start is the website for the American Society of Ophthalmic Plastic and Reconstructive Surgery (asoprs.org) where you can find a link to surgeons in your area.

Andrew Harrison, MD, Director, Oculoplastic and Orbital Surgery, Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota

A 2: There are certain contacts that can be successfully worn by dry eye patients. Conversely, having a wet eye is not an absolute contraindication to wearing contact lenses. Both situations depend on a variety of factors. You would need to be evaluated by your eye doctor to determine your best options.

James R. Patrinely, MD, Plastic Eye Surgery Associates, Houston, Texas and Pensacola, Florida

Q: I have tardive dyskinesia, and I have had in mind taking some activated carbon. I have been studying this and how to make it. I believe I can do it. I am interested in your thoughts on this. I realize this can be used for acute poisoning, but also it can remove toxins from the body, and maybe it will remove enough toxins to help with the rebuilding of cell structure that is need to possibly heal this. Please let me know how you feel about this activated carbon and its affects.

A: Tardive dyskinesia is a neurological disorder manifested by abnormal involuntary movement ("dyskinesia"), typically involving the face but it can affect any part of the body, caused by exposure to drugs that block dopamine receptors, also known as neuroleptics. Most of these drugs are used for a variety of psychiatric problems but some are used to control nausea and other gastrointestinal conditions. The movements may resolve once the offending drug is discontinued, but in many cases, particularly elderly women, the dyskinesia may persist. I would suggest that you consult a movement disorder neurologist to recommend the most appropriate treatment, such as tetrabenazine. There is absolutely no scientific evidence that "activated carbon" can be useful in the treatment of tardive dyskinesia.

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

Q: I have been suffering from blepharospasm and Meige for 15 years. BOTOX® injections have a 75% effect that lasts for approximately two months. As a complement, in between injections, I'm presently trying acupuncture with someone who has never heard of blepharospasm. Do you have any information on that type of treatment for blepharospasm? Also, could hyperbaric chamber treatment be of help to treat blepharospasm?

A: Acupuncture may help some patients, but there is no known procedure better than any other. As to hyperbaric oxygen, there is no reason that it should help since the brain is not short of oxygen in blepharospasm.

Q: I am a pediatrician who suffered from benign essential blepharospasm for several years. I am writing to raise your awareness about a new device for migraines that I wonder if it may have some application for use in BEB. A transcutaneous neurostimulator for the supraorbital nerve called the Cefaly has recently been FDA approved for use in the United States for prevention of migraine.

It has been used in Canada and Europe for several years, apparently with a good safety record. When used daily for 20 minutes, it is supposed to decrease trigeminal nerve hyperexcitabilty, which has been proposed as a mechanism for both migraine and blepharospasm. Have there been any research studies on this device with BEB patients?

A: We funded the investigator at UCLA to study this, but I don't think he ever finished his project. So, it is an interesting idea, worth pursuing, but I am not sure whether anyone is at present.

Mark Hallett, MD, Chief, Human Motor Control Section, NINDS, NIH, Bethesda, Maryland


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