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See the expert for eyelid movement conditions

Oculoplastic surgeons were the first to treat ocular movement disorders, eyelid spasms conditions such as blepharospasm and hemifacial spasm. Dr. Sherman has extensive experience with Botox, the first treatment, as she has been injecting it for over 20 years, since its FDA approval in 1989.

Dr. Sherman is a National and International Trainer for Botox and has taught her Master Injector techniques extensively with other physicians in the US, as well as Russia and China. Dr. Sherman has also been injecting Xeomin since its recent FDA approval in 2011. This level of experience and expertise in the injection technique makes Dr. Sherman a well-qualified specialist with the highest level of training to treat Blepharospasm and Hemifacial Spasm.

Dr. Sherman specializes in the different many types of operations to help the rehabilitation of patients with facial nerve palsy. Because she is a Board-Certified Ophthalmologist and Fellowship trained in plastic surgery around the eye, she can evaluate and advise you on all available treatment options.

Blepharospasm & Hemifacial Spasm

Blepharospasm

BeforeAfter

Note severe spasms around the eyes in patient prior to treatment.

Note loss of spasms around the eyes after treatment.

Blepharospasm (blef′ă-rō-spazm′) is the medical term for involuntary eyelid spasms or uncontrollable blinking around the eyes. In blepharospasm, also called benign essential blepharospasm (BEB), eyelid spasms can become so severe that one becomes debilitated from an inability to open the eyes well enough to see. As the condition progresses, the spasms may intensify, forcing the eyelids to remain closed for long periods of time, and thereby causing functional blindness. It is important to note that the blindness is caused solely by the uncontrollable closing of the eyelids and not by a dysfunction of the eyes. BEB occurs in both men and women, although it is especially common in middle-aged and elderly women.

In approximately two thirds of patients with blepharospasm, the condition develops after 50 years of age. Women are affected twice more often than men. The prevalence of essential blepharospasm is estimated to be 5 per 100,000. Factors that may exacerbate blepharospasm include reading, talking, bright light, stress, and driving.

Hemifacial Spasm

BeforeAfter

Note severe spasms around the eye in patient prior to treatment.

Note loss of spasms around the eye after treatment.

Hemifacial spasm is the medical term for abnormal twitching and spasms of one side of the upper and lower face. It can cause the eye on the affected side to have functional blindness and inability to see due to the constant closure of the eyelids on that side of the face.

Is There a Treatment?

In most cases of Blepharospasm and Hemifacial Spasm, the treatment of choice is botulinum toxin injections. There are several formulas; the most commonly used is Botox. Recently, a new formulation of botulinum toxin has been introduced called Xeomin. Xeomin is a newly FDA approved botulinum toxin in the US; however, Xeomin has been used in Europe for years. Both Botox and Xeomin are formulas of botulinum toxins (neuromodulators) that are purified proteins which relax the muscles and stop the spasms.

Dr. Sherman has had extensive experience with these neuromodulators for over 20 years. Her level of experience and expertise in the injection technique makes Dr. Sherman a well-qualified specialist with the highest level of training to treat Blepharospasm and Hemifacial Spasm.

What is the prognosis?

With botulinum toxin treatment given with Dr. Sherman’s Master Injector technique, most individuals with Blepharospasm and Hemifacial Spasm have substantial relief of symptoms.

As with any medical treatment, side effects can occur. Dr. Sherman and her staff will thoroughly evaluate your symptoms and findings to see if you are more prone to any side effects of the botulinum toxin therapies. Because the treatment effects wear off with time, almost all of the potential side effects are temporary.

What are other treatment options?

There are many medications (drug therapy) or surgery that have some limitations that you can discuss at the time of your consultation.

In a tiny minority of patients in whom botulinum toxin injections are not tolerated, surgery may be necessary.

Many medications of different classes have been tried unsuccessfully for the treatment of essential blepharospasm, including benzodiazepines (e.g., clonazepam), anticholinergics (e.g., trihexyphenidyl HCl; benztropine), and GABAergics (e.g., baclofen). Generally, with these medications, significant adverse effects occur before blepharospasm is reduced.

Incomplete Eyelid Closure or Lagophthalmos

BeforeAfter

Note incomplete lid closure before surgery.

Note improved eyelid closure after surgery.

Lagophthalmos (lag′of-thal′mŏs) refers to the condition in which an eyelid does not close completely. The lid may appear normal when open, but the problem occurs when attempting to close the lid. When the eyelid does not adequately close, the cornea is exposed to the air and the eye surface dries out. Drying of the eye in turn leads to light sensitivity, tearing, and irritation. In more severe cases, scarring and infection of the front surface or the eye or cornea can develop.

The facial nerve is a nerve which supplies the muscles of the facial expression and the tear gland of the eye. The term Bell’s Palsy describes a sudden weakness of the facial muscles due to paralysis of facial nerve. Facial nerve palsy is a wider term describing weakness of the face due to loss of function of the facial nerve.

The causes of facial nerve palsy are numerous and include tumors, strokes, infections, trauma, and surgery. The vast majority of facial nerve palsies are sudden, self-resolving, and without apparent cause, which is the case with Bell’s palsy. Loss of function of the facial nerve can have quite marked consequences on the face.

Problems which can arise include:

  • Lagophthalmos, the inability to close the eye due to paralysis of the muscles of the upper and/or lower lid
  • Ectropion, an out-turning eyelid due to paralysis of the lower lid
  • Corneal exposure, ulcers of the corneal surface due to inadequate moisture
  • Brow Ptosis, drooping of the eyebrow due to paralysis of the forehead muscles
  • Midface/Cheek Ptosis, drooping descended cheek due to paralysis of the cheek muscles
  • Abnormal spasms of the facial muscles, due to abnormal healing of the damaged nerve
  • Crocodile tears, excess tear production which occurs when chewing

Surgical Rehabilitation

Oculoplastic surgeons such as Dr. Sherman specialize in the different many types of operations to help the rehabilitation of patients with facial nerve palsy. Because she is a Board-Certified Ophthalmologist and has been fellowship trained in plastic surgery around the eye, Dr. Sherman can carefully evaluate the lid and corneal function with a bio-microscope in order to customize the treatment plan. Each patient needs to be treated on an individual basis. Different patients with facial nerve palsy will have different clinical features with varying severity of problems.

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