Eyelids closing and head pains

[imankhan]

My mother in law is having problems after Cataract surgery. She has great difficulty physically keeping her eyelids open and is having forehead and scalp muscle tension/pain from straining those muscles constantly.

She had one cataract removed and after two months she started with these unpleasant symptoms. They are getting increasingly worse. After complaining,she was seen by another eye specialist who said these symptoms were unrelated to the cataract operation. He said her brain signals were over-active/too strong and gave her some injections (into the facial nerves) to try weaken them. This has had no effect.

She is becoming increasingly disabled by these symptoms and cannot leave the house now. She is holding on to the furniture and walls for safety as her vision is so restricted.

Have you any idea what may be going on here?

I cannot be more specific with technical/medical information because my mother in law is in Pakistan and does not get given the same amount of information as we do in the West.

We can get her treated in the UK if we could just find out what the problem is.

[imankhan]

I've spoken to her and read up on the conditions you suggested she may have.

Her symptoms suggest your first thought was correct, Benign Essential Blepharospasm. We're so relieved to understand what the problem is. We've called her and told her to get good sleep and to stop worrying, relax etc and continue to be patient and try the various drug therapies. Obviously, the surgical treatment is the last resort but it has a good outcome in 75-80% of patients.

She says her symptoms are better after a good night's sleep and worse if she is stressed. We've reassured her that she is getting the same care in Pakistan as she would be getting anywhere else so she isn't worrying about that any more. I've found the Benign Essential Blepharospasm Research Foundation website to be very informative and helpful too.

Thank you again for your help and if you have any suggestions for us we would be very grateful.

[imankhan]

It sounds like the injections she was given could have been botox then? If it was, should that have worked quickly? They said it should work after around 70 hours but there's been no change and it is 6 weeks ago approx.

Her eyes are not sore, dry, painful etc... she just can't keep the lids open. These symptoms are in both eyes, though she only had one cataract removed.

Do you think these problems are due to the cataract surgery or are they coincidental?

Thank you in advance for your help. I'll look up the conditions you have mentioned and see if I can get more specific information to help you.

Obviously, if we can find out what the problem actually is, then we could bring her here and pay for treatment for her as she is very disabled by these symptoms and we'd do anything to help her get well again.

[Michael J Kutryb, MD]

She could have essential blepharospasm or hemifacial spasm which make her eyelid closing muscle clamp  down a lot.  Can be treated with BOTOX for some cases.  Also she could have a painful keratopathy which could be diagnosed in the office and treated accordingly.  Sorry, but I can't help any more without knowing her case.  The real issue is does she just have eyelid spasms by themselves or are the eye closing because they are dry and painful???.

MJK MD