Eyelid Problems in PSP
Patients with PSP blink less frequently, giving the impression that the patient is staring. Because the blink reflex wipes out tears, the reduced rate of blink can lead to an accumulation of tears. This may lead to transient blurring of vision.
Sometimes patients experience repeated spasms of the eyelids leading to forceful closure of the eyes. This is called blepharospasm. A milder version of this is apraxia of eyelid opening. The patient has preserved the ability to blink, but, from time to time, they cannot open their eyelids after blinking. Often the person is forced to use their fingers to manually lift the eyelids.
Treatments
There are several ways of managing the eye symptoms. Unfortunately, there is no satisfactory treatment of paralysis of eye movements. Eye exercises are futile. Patients who cannot look down and read through their bifocals should hold the reading material higher to eye level so that when they read, the eyes are positioned straight ahead rather than down. Use of a ruler may help in finding the beginning of the next paragraph. Special prism glasses best help patients who have convergence insufficiency. Those who can’ t look side to side are advised to train themselves to turn their heads while walking and driving.
Blepharospasm and apraxia of lid opening are treated with botulinum toxin injections into the area around the eyelids. The results are good but last only for three to four months. Repeated injections are necessary to keep the condition under control.
Taping the eyelids gently to the forehead is another simple method to keep lids open.“ Eyelid crutches” attached to glasses can also help keep the lids open. Finally, in the worst-case scenario, surgery may be necessary to remedy eyelid spasms. The surgeon removes part of the muscle responsible for eyelid closure. In the hands of an experienced plastic surgeon, results are often good, rendering an acceptable aesthetic appearance.
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As discussed earlier, dry eye is easily treated by liberal use of lubrication eye drops that are available over the counter.
Speech, Communication, and Swallowing
Laura Purcell Verdun, MA, CCC / SLP
Overview of the Role of the Speech-Language Pathologist( SLP)
As with any progressive neurological condition, early intervention is the key to maintaining or increasing communication effectiveness and swallowing function. At the time of diagnosis, or as soon as a patient or carepartner notices changes in speech or swallowing, is the time to seek a referral for a certified and licensed speech-language pathologist( SLP). SLPs are healthcare professionals trained to evaluate and treat individuals with speech, voice, language, and swallowing problems. It is much easier to learn effective strategies and techniques to keep the speech and swallowing mechanisms highly functional than it is to rebuild what is lost. Additionally, strategies can be implemented to compensate for impairment. It is never too late to seek an SLP and get assistance to promote speech and swallowing ability.