No abstract available.
Blepharoplasty* ; Blepharospasm* ; Eyelids*

PURPOSE: To compare clinical efficacy and duration of Hugel-tox(R) (also known as Botulax(R)) and Botox(R) for the treatment of essential blepharospasm. METHODS: A total of 48 patients who were injected with Hugel-tox(R) (17 females, 7 males) or Botox(R) (18 females, 6 males) from February 2013 to October 2013 were enrolled in the present study. Changes in eyelid closing force and Scott grade before and after injection were analyzed. Adverse events were also evaluated. RESULTS: There were no significant differences between the Hugel-tox(R) and Botox(R) groups in clinical efficacy and duration. Before and after injection, changes in Scott grade (Hugel-tox(R): -1.17 +/- 0.70, Botox(R): -1.21 +/- 0.72, p = 0.840), changes in eyelid closing force (Hugel-tox(R): -1.38 +/- 0.58, Botox(R): -1.17 +/- 0.56, p = 0.212) and duration (Hugel-tox(R): 116.08 +/- 22.12 days, Botox(R): 126.92 +/- 38.94 days, p = 0.242) were shown. No serious adverse events were found in either group. CONCLUSIONS: Hugel-tox(R) showed nearly equal efficacy and duration compared with Botox(R).
Blepharospasm* ; Eyelids ; Female ; Humans

PURPOSE: This study was conducted to determine if there is a corneal astigmatic change in patients with strong lid tension, such as essential blepharospasm. METHODS: Twenty-two eyes of 14 patients with blepharospasm who had undergone botulinum toxin A (Botox(R), Allergan) injection during the period February 2001 through January 2002 were included. The corneal astigmatic change was evaluated before injection and after 1st month and 6th month of injection by keratometric measurements. Corneal astigmatism was measured before and 1month after botulinum toxin A injection and changes of corneal astigmatism were checked using vector methods (corneal astigmatism change vector). RESULTS: The with-the-rule astigmatism group showed decreased average corneal astigmatism while the against-the-rule group showed increased astigmatism at 1month after injection. The corneal astigmatic change vector showed significantly greater against-the-rule change (16 eyes) than with-the-rule change (6 eyes) at 1 month after injection. CONCLUSIONS: We found that the corneal astigmatism was influenced by botulinum toxin A injection in patients with essential blepharospasm who seemed to have strong lid tension. Therefore it was proved that the corneal astigmatism was influenced by lid tension.
Astigmatism* ; Blepharospasm ; Botulinum Toxins* ; Humans

PURPOSE: To compare the clinical efficacy, duration of effect, and safety of Dysport and Botox for patients with essential blepharospasm using functional disability scale. METHODS: Patients with a confirmed diagnosis of essential blepharospasm who had received Botox (Allergan, USA) from September 2006 to May 2007 were enrolled in this study. We switched from Botox to Dysport (Ipsen, UK) after the botulinum effect of previous injection had disappeared and compared the clinical efficacy of two drugs. We used a 2.5:1 Dysport:Botox conversion ratio. The clinical efficacy of the drugs treatment was evaluated using a functional disability scale. We compared the duration of the effect and the safety of the two drugs. RESULTS: The study included 48 patients (43 women, 5 men). There was no significant difference in mean functional disability scores or in any item of the functional disability scale. There was no significant difference in duration of effect between Botox (100.2+/-37.34 days) and Dysport (99.1+/-39.7days). There was also no significant difference in frequency of adverse reaction between Botox (13%) and Dysport (10%). CONCLUSIONS: When a dose conversion of 2.5:1 Dysport:Botox was used for essential blepharospasm patients, the two drugs displayed almost identical clinical efficacy, duration of effect, and safety.
Blepharospasm ; Botulinum Toxins, Type A ; Female ; Humans

Pretarsal motor persistence (PMP), a subtype of apraxia of the eyelid opening, is characterized by the inability to open the eyelids at will due to persistent activity of orbicularis oculi muscles following voluntary closure. Here, we describe clinical characteristic and the synchronous EMG recording from the levator palpebrae and orbicularis oculi muscles of PMP in patient with essential blepharospasm, idiopathic Parkinson's disease, and progressive supranuclear palsy.
Apraxias ; Blepharospasm ; Eyelids ; Humans ; Muscles ; Parkinson Disease ; Supranuclear Palsy, Progressive

On the proposed fluorescein clearance test by Pflugfelder and Tseng, measurements of volume and concentration of instilled fluorescein, being changed by tear secretion, pumping action, during confined time, are able to discern tear turnover rate(tear clearance). We performed TBUT, Schirmer test and modified FCT to the 60 eyes of healthy person, to the 36 eyes of essential blepharospasm patient, and to the 32 eyes of hemifacial spasm patients. We modified the FCT to economize time. Under the topical anesthesia with 0.5% propacaine, test was performed after instilling a 20 microliter of Flucaine(0.25% fluorescein sodium, and 0.5% propacaine) into the conjunctival sac and standard Schirmer strip was then placed for another 10 minutes. The length of the portion was measured and the concentration of tint fluorescein was graded into 5 degrees(photodocumented classification under the cobalt blue light)(FCT 1). Waiting 10 minutes, a standard Schirmer strip was placed into with nasal stimulation and length and concentration was also measured(FCT 2). The agreement of classification was determined with Kappa values for evaluation for reproducibility and and reliability of FCT. The intra-observer agreement(examination repeated twice) was k=0.84 and the inter-observer agreement(two obsevers' examination) was k=0.77, which revealed a consistent result. Patients with blepharospasm was indicated decreased basal secretion compared with normal control(p<0.001) and also showed delayed tear clearance whith represented significant increased concentration(p<0.001). We concluded that FCT was revealed high reproducibility by intra-observer and inter-observer agreement and test may be useful diagnostic method to evaluate delayed tear clearance.
Anesthesia ; Blepharospasm* ; Classification ; Cobalt ; Fluorescein* ; Hemifacial Spasm ; Humans ; Tears

Tardive blepharospam is characterized by repetitive, forceful, and sustained involuntary contractions of the orbicularis oculi. We report here one case of neuroleptic-induced tardive blepharospasm that developed during high-dose amisulpride treatment and was treated with clozapine. The patient was a 29-year-old man with a 6-year history of schizophrenia. After 33 months of amisulpride treatment (1200 mg/day), involuntary eye-blinking had developed. Following exclusion of all other possible etiopathological causes of the blepharospasm, we decided to switch the drug treatment from amisulpride to clozapine. On the fourteenth day of clozapine (250 mg/day) treatment, we observed significant improvements in eye-blinking and psychotic symptoms. Four months later, the eye-blinking had remitted completely. We suggest that amisulpride may cause blepharospasm and lead to an impaired ability to perform daily activities. Therefore, we recommend that clinicians regularly monitor involuntary movements in patients receiving antipsychotic treatment, especially when high doses of amisulpride are involved.
Adult ; Blepharospasm ; Clozapine ; Contracts ; Dyskinesias ; Humans ; Organothiophosphorus Compounds ; Schizophrenia ; Sulpiride

To investigate results of treatment with essential blepharospasm, patients were evaluated by results of treatment with botulinum toxin A and myectomy operation. Seventy patients of the essential blepharospasm who received local injection of botulinum toxin or orbicularis muscle extirpative surgery were evaluated according to results and complications of the treatment modality over a 7-year period. Fifty-six patients[80%] were primarily treated with botulinum toxin and 14 patients[20%] underwent myectomy operation as the primary treatment. Of the 56 patients, 8[14.3%] were treated later with myectomy operation. In botulinum toxin treatment, the mean subjective improvement was found in 89.2% of the patients, and the mean effective durations of essential blepharospasm were 12.7 weeks. Severity and frequency grades in eyelid spasm were significantly lower after injection[P=.000]. Tearing, dry eye, and headche were the most frequent complications and ptosis was observed in 2 cases[2.0%]. In the orbicularis myectomy operation, 13 patients[59.1%] were carried out through a brow incisions, 1[4.5%] through a blepharoplasty incisions, and 8[36.4%] through both. Fourteen patients[63.6%] had acceptable control of blepharospasm throughout follow-up after the upper lid orbicularis stripping procedure alone. We believe that botulinum toxin is the treatment of first choice because of its higher acceptance rate. Surgery is reserved for botulinum toxin failure. In otherwise fit patients, myectomy is the treatment of first choice.
Blepharoplasty ; Blepharospasm* ; Botulinum Toxins* ; Eyelids ; Follow-Up Studies ; Humans ; Spasm

PURPOSE: Direct injection of doxorubicin into the eyelids results in permanent loss of muscle fiber and it is considered an attractive nonsurgical method in essential blepharospasm therapy. However, necrosis of skin overlying orbicularis oculi muscle is the most serious side effect of this therapy. The purpose of this study is to determine the effect of doxorubicin delivered by osmotic pump which release doxorubicin slowly, and to evaluate the degree of overlying skin injury following chemical myectomy. METHODS: Thirty three rabbits were assigned to three groups according to the doxorubicin concentration. The first group received direct injections of 0.5 mg doxorubicin diluted in 0.1 ml of saline in the right lower eyelid. and osmotic pump was inserted into the left lower eyelid which contained 0.5 mg doxorubicin in 0.1 ml of saline. The second group received 1 mg doxorubicin and the third group received 2 mg doxorubicin. Eight weeks after injection, the eyelids were assessed for the degree of muscle fiber loss microscopically. For the evaluation of functional change of muscle, an EMG study was carried out. RESULTS: Skin necrosis developed in all rabbits except for one which received injection of 0.5 mg doxorubicin. Skin necrosis appeared earlier in the direct injection group. The duration of skin necrosis was shortened at lower concentrations(0.5 mg, 1.0 mg) with a pump delivery(P<0.05). But there was no statistical differences in the 2.0 mg concentration. The size of necrosis was much smaller in rabbits using pump delivery than those of direct injection group in high doxorubicn concentrations(1.0 mg, 2.0 mg)(P<0.05). The total size of muscle fiber was decreased after a doxorubicin injection. There was no statistical difference between the direct injection group and the pump group(P<0.05). The similar effect on the muscle was noted regardless of the slow release of the doxorubicin into the muscle. Light microscopic study demonstrated destructive change of muscle and it was replaced by connective tissues. Electron microscopic study showed destruction of micro-architecture of muscle fibers. Functionally, in EMG study, there was no motor activity in the injection area. But some motor unit potentials appeared in the periphery of skin necrosis site. CONCLUSIONS: These results suggest that the osmotic pump may be used as an effective adjuvant in preventing skin necrosis in blepharospasm treatment.
Blepharospasm ; Connective Tissue ; Doxorubicin* ; Eyelids* ; Motor Activity ; Necrosis* ; Rabbits ; Skin*

Blepharospasm is a focal dystonia that consists of repetitive involuntary spasmodic contractions of the orbicularis oculi muscle. A 27-year-old man was admitted with ptosis and involuntary blinking in both eyes. He was diagnosed as having schizophrenia when he was 15 years old and medicated with chlorpromazine for 12 years. After excluding all the possible etiopathological causes of the blepharospam, the offending drug was discontinued and changed to an atypical antipsychotic, clozapine. Clozapine was increased up to 75 mg in the 7th day of admission, and the symptoms were slowly ameliorated.
Adolescent ; Adult ; Blepharospasm* ; Blinking ; Chlorpromazine ; Clozapine ; Dystonic Disorders ; Humans ; Schizophrenia