ANA Discussion Forum
Post-Treatment => Eye Issues => Topic started by: ToddH on November 04, 2009, 04:13:22 pm
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As some of you know, I am facial PT in Pittsburgh (yeah, please don't hold it against me that we have 2 world champions at the same time :)) Thought it might be useful to share a basic eye exercise that can often get the eyelids strong enough to do their job again (and avoid surgery). You may know that when the eye rolls up during closure, it's called a bells phenomenon. It's a protective reflex that occurs when the eyelids themselves are too weak to fully close. It's a good thing, but may outlive its need, and keep going anyway due to habituation (once a brain, or neural, pattern is established it tends to stay that way). Here's the thing, when the eye rolls up, the lights go out, and you and more importantly, unconsciously, the brain thinks the eye is closed. So there is no more motivation for the brain to send signals to the eyelids (orbicularis oculi superiorus and inferiorus) to keep working. So they don't work any harder.... and they never get stronger for this reason. As long as your eyeball rolls up, the eyelids don't need to get stronger and they often stay "lazy".
Now one important caveat: sometimes there really isn't enough nerve fibers regenerated to the eyelids, in which case the following exercise will not work. However, my years of experience have taught me that this caveat problem is less common that you think.
Here is the exercise: sit straight, look down at your hand in your lap (or on table), close your eyes as far as you can without losing sight of your hand (and allow the good eye to close all the way). This should result in your weak eyelids closing partially - the goal is a slit that you can still see your hand through. This may not happen immediately, it may take some practice. You may feel some initial eye strain. Don't push it hard. After a number of reps, it should start to get easier. If you lose sight of you hand, it is because your eye rolled up, not because you eye fully closed... so it is critical to this exercise that you do not lose sight of your hand at the beginning. Hold there for 5 count, then either try to close all the way while still looking down, or use a finger to finish the close (you need someone to tell you if it rolled up or closed fully if you try the former). Once shut, take finger way slowly while still looking downward and squeezing the eyelids shut a little (not a lot to keep cheeks out of it), then hold 5 or 10 more count. Reopen, relax. I give this, or a variation, to almost every pt. I treat with eyeclose (during day) problems. Usually 10 reps 2 or 3 times a day.
Hope this is of use. Obviously, I'd suggest doing under supervision of a therapist, but knowlege is power, right! In my years (since 1992) I've never had anyone harmed by this exercise. Understand that this is only a suggestion and an option, and I take no responsibility for success or failure. Any questions?
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Thanks for the info! I'm in a fairly small town where my issue is quite a rarity, so there isn't much offered locally in the way of treatment. I do have a wonderful doctor in Dallas, but that is 2-1/2 hrs away. My eyelid is just a sliver away from closing all the way by itself (can close when the other one is shut), so I'll try anything I can to strengthen it and maybe "push" the progress further. Like you say, it can't hurt ;D Thanks again!
Cheryl C
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Thanks for posting that. Now I'm proud because I actually figured that out by myself and have had full closure even laying flat on my back for about 3 months now. So it really does work!!
Vonda
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My therapist gave me this exact exercise to do. I did it for about a month and was about to give up because it seem like a waste of time. Nothing was happening. Then one day, I noticed that I was having a hard time seeing my hand, my eye was almost closed. So. . . .yes, it does work!!! I'm so close to a complete closure! If I keep doing this maybe I won't need a gold weight! At least that is my goal.
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It took me almost three months of physical therapy before I could close my eye. There were alot of times I almost gave up because I didn't see improvement for days or even weeks. Some times I saw improvement every day and then other times less movement than the day before. Patience, patience, and alot of patience is what you need. God luck.
Dan in Germany
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Thank you Todd, very interesting. I have avoided an eyelid weight and can almost close my eye. I am sure it is rolling back and my facial PT is off on medical leave so I am going to try this and push my eye just a bit more. I will keep you posted.
Michelle ;D
Never giving up hope!
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Okay Todd so I tried the exercise and found that when I look down and started to close my eye, my cheek becomes involved.
Any advice?
Michelle ;)
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I have the exact same problem. My PT says it's very common. I find when I can close my eye without cheek movement after seveal repetitions. It takes me at least 3 to get it right. Pactice makes perfect I guess. But remember it's taken me several months to get this far. It's a slow process just like all other things AN.
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Michelle, yes, sometimes the cheek gets involved no matter what and you just have to go with it. Later, as the eyelids strengthen you may be able to relax the cheek better. Sometimes I'll have person stroke the cheek down with hand as they close to try to get it to relax more. This synkinesis pattern is "ocular to oral" and it can manifest itself as the mouth corner twitching with every blink at its' worst. I'll sometimes get patients who have this chronically and will try the hand/finger stroking down technique or just aggressive cheek massaging to work on reducing it, but it is hard. You can't Botox the cheek to stop it because then you cause midface drooping and weaken the smile.
Just be aware of it and try to minimize it, if able.
Todd
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Thank you Todd!
Lots of zaps and twitches in the eyelid (17 months post op) so I am feeling optimistic. If only the corner of my mouth would cooperate. ::)
Michelle ;D
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Thanks...while my eye has gotten better I still don't get complete closure. Hope this helps.
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Thank you for this exercise! I am almost 18 months post op and scheduled for gold weight surgery in May. It would be wonderful to avoid that. I'm really looking for others experiences w/the gold weight surgery. Chris