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From the Departments of Ophthalmology (Drs. Baker, Sun, Hasan, Chuke, Cowen, and Porter, and B.R. Rouholiman), Neurology (Dr. Baker), and Anatomy and Neurobiology (Dr. Porter), University of Kentucky Medical Center, Lexington.
Address correspondence and reprint requests to Dr. Robert S. Baker, Department of Ophthalmology, E304 Kentucky Clinic, University of Kentucky Medical Center, Lexington, KY 40536-0284.
We described four patients with Bell's palsy and blepharospasm and evaluated potential mechanisms that may be responsible for an apparent association between the two disorders. Eyelid movements in spontaneous blinks were studied by the search coil technique in patients with this novel disorder. Kinematic analyses documented bilateral eyelid spasm subsequent to unilateral Bell's palsy. The temporal interval between the onset of palsy and onset of blepharospasm was highly variable (weeks to >20 years). Changes in the relationship between spontaneous blink peak velocity and amplitude, the main sequence, shared features previously found in uncomplicated Bell's palsy and blepharospasm patients. Furthermore, as in patients with typical Bell's palsy and idiopathic blepharospasm, both normal blinks and spasms were conjugate in spite of interocular differences in blink amplitude/peak velocity. We suggest that there is a correlation between the eyelid palsy and subsequent blepharospasm, and have designated this potentially new disease entity as Bell's palsy-induced blepharospasm. We propose a two-stage model for Bell's palsy-induced blepharospasm in which blink adaptive systems may produce the maladaptive consequence of eyelid spasms.
Supported by a grant from the Benign Essential Blepharospasm Research Foundation, USPHS grant EY10760 from the National Eye Institute, and an unrestricted grant from Research to Prevent Blindness, Inc. B.R.R. was supported by a Howard Hughes Medical Institute Undergraduate Research Fellowship. J.D.P. was the recipient of a Research to Prevent Blindness Lew R. Wasserman Merit Award.
Received July 15, 1996. Accepted in final form January 16, 1997.
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