Eyelids On The Blink?

Injections, surgery bring relief for incessant, involuntary eye spasms.

Dr. Jennifer Landy at Brandon Eye Associates treated Ellen McDonnell’s eyelid spasms and droopy eyelids using ptosis repair and blepharoplasty surgery.An insurance adjustor since graduating from college, Ellen McDonnell investigated countless incidents before retiring in February 2017. The types of cases she scrutinized fluctuated with the weather.

“It all depended on the time of year,” Ellen elaborates. “If it was snowing outside, I saw more slips and falls. If it was sunny, there were typically more car accidents.”

For most of her career, Ellen worked for USAA, which insures members of the military and their families. She followed that with a stint at Crawford & Co., the world’s largest independent provider of claims management. 

“My job was always interesting because it wasn’t repetitive,” Ellen reflects. “Every time I took care of an accident, it was something new.”

After she retired, Ellen started to experience uncomfortable eye issues. It started with her eyes becoming extremely dry, which led to more aggravating conditions.

“My dry eye turned into a problem with excessive blinking,” Ellen shares. “The constant blinking was very irritating and started to negatively affect my life.

“On a scale of one to 10, with 10 being the most uncomfortable, my blinking condition was a six or seven. But you learn to live with the hand you’re dealt, so I tolerated it for the most part, but it was very annoying.”

Between May 2017 and September 2018, Ellen visited 10 eye specialists in Tampa, but none could find a way to help her dry eyes or halt her constant blinking. Finally, a Tampa ophthalmologist referred her to Brandon Eye Associates. That’s where she met Jennifer Landy, MD, a board-certified ophthalmologist specializing in oculoplastic surgery, which includes surgery on the eyelids.

“Ellen came to us after seeing other oculoplastic physicians who diagnosed her with blepharospasm, a neurological disorder where the eyelids spasm and persistently close,” Dr. Landy recalls. “Patients with this condition typically have difficulty performing their activities of daily living because their eyes constantly squeeze shut.

“The standard treatment for blepharospasm is an injection into the muscles around the eyes of a neurotoxin such as BOTOX®. The BOTOX stops the muscles from contracting, which relieves the spasms. We decided to use a different, though very similar, medication called XEOMIN®. That’s what we treated Ellen with and she started to improve.” 

Ellen received her first injection of XEOMIN in October 2018. Since then, her blinking problem has improved markedly. So, too, has an issue she had with excess skin on her eyelids that Dr. Landy offered to correct.

Secondary Syndromes

“It’s not unusual for people over the age of 60 to have excess skin on their eyelids,” Dr. Landy explains. “It’s a condition called dermatochalasis, or baggy eyes, and while it’s caused by an age-related loss of skin elasticity and the weakening of the eyelid’s connective tissue, it’s occasionally seen in young adults as well.”

Ellen also suffered with ptosis, or droopy eyelids, a condition generally caused by a loss of strength in the eyelid muscle. With ptosis, the upper eyelid droops down over the eye. In severe cases, the eyelid may even block the person’s vision. 

“Sometimes, correcting these issues will help the blepharospasms,” Dr. Landy discloses. “We discussed the potential benefits of corrective surgery, and Ellen chose to proceed with surgery to try to further improve her eyelid spasms.”

The surgeries Dr. Landy recommended included a ptosis repair, a procedure to lift the drooping eyelids by tightening or shortening the eyelid muscle. Dr. Landy also suggested Ellen undergo a blepharoplasty, which would remove excess skin from Ellen’s upper eyelids. 

“During the blepharoplasty, the surgeon also removes some of the orbicularis muscle, which assists with contracting and closing the eyelids,” Dr. Landy explains. “It is believed that by removing part of that muscle, the eyelid spasms will decrease. Unfortunately, the orbicularis tends to grow back over time, so while the blepharoplasty helped lessen Ellen’s blepharospasms, it wasn’t a cure.”

Until a cure is found, the most effective treatment for the uncomfortable eyelid spasms remains injections of a neurotoxin such as BOTOX or XEOMIN. These injections are typically delivered every three months for the remainder of the patient’s life. 

“Ellen’s condition responded extremely well once we put her on XEOMIN, increased her medication dose and changed the location of her injections,” Dr. Landy reports. “She is now a much happier person and is much more functional. Her improvement has been remarkable, so we were able to extend the time between her injections.”

When Ellen began treatment at Brandon Eye Associates, she received XEOMIN injections every six weeks. Because of her progress, her injection schedule was expanded to every 12 weeks. Ellen was happy to spread out the time between injections, which she finds unpleasant but not painful.

“Dr. Landy places about 10 injections in different areas around each eye,” Ellen states. “It’s not very comfortable, but Dr. Landy has a way of making those injections almost seem pleasant.”

“Best Medical Team”

Ellen visited 10 doctors before seeing Dr. Landy and finally finding significant relief for the constant blinking. The answer included XEOMIN injections, a ptosis repair and blepharoplasty surgery. 

“Dr. Landy operated on my eyes on May 8, 2019, and the surgery really helped,” Ellen enthuses. “The blinking has decreased dramatically. We’re both hoping there will be a cure soon. In the meantime, I have to learn to live with the condition. But it has improved a lot. On the scale of one to 10, its now a three or four instead of a six or seven.”

Not only is Ellen happy with her outcome, she’s impressed by Dr. Landy and her staff. 

“I love Dr. Landy,” she raves. “I think she walks on water. Her bedside manner is fabulous. She’s empathetic and cares about her patients. She’s a good, good person. And her assistant is like Radar O’Reilly on M*A*S*H, a step ahead of Dr. Landy. She and Dr. Landy are the best medical team I’ve ever worked with.”

© FHCN article by Patti DiPanfilo. js
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    • Brandon Eye Associates, PA

      The doctors at Brandon Eye Associates use their hearts to help care for your eyes. In addition to being lauded, board-certified physicians at the height of their careers, your Brandon, Sun City Center and Plant City Ophthalmologists are car... Read More

    • Jennifer Landy, MD

      Jennifer Landy, MD, is board-certified in ophthalmology and oculoplastic surgery. She earned a BA degree with honors in economics and premed from University of Wisconsin in Madison. She received her medical degree cum laude from University of M... Read More