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Peter from Brisbane reports on his meeting with Dr Richard Anderson in Salt Lake City
We arrived in Salt Lake City on December 13th. Salt Lake City is a beautiful city nestled in a valley between two picturesque snow-capped mountain ranges. The temperature range on that day ranged between -10 degrees Celsius to -2 degrees Celsius, so this was a certainly a contrast to the high temperatures we had left behind in Brisbane.
I arrived for my appointment and was promptly given an eye test by one of Dr Anderson's staff. She also took a number of photographs of my eyes. Once this part of the consultation was completed, I was introduced to Dr Anderson's associate, Dr John Burroughs. Dr Burroughs was interested in the cosmetic component of BEB treatment. As Dr Burroughs explained, the constant and forceful blinking which is characteristic of Blepharospasm causes stretching and drooping of the eyelids. In my case, some drooping (ptosis) of the eyelids was evident, but this was not severe enough to warrant cosmetic surgery at this point, as this slight drooping was not interfering with my vision.
Shortly after Dr Burroughs left me, a tall smiling figure dressed in a business suit and cowboy boots entered the room. This was Dr Richard Anderson. Dr Anderson is a charming man who immediately made me feel welcome and relaxed. I know that Dr Anderson is a very busy man, but he was able to spend almost an hour of his valuable time chatting with my wife and myself about the various aspects of Benign Essential Blepharospasm.
I explained to Dr Anderson that Botox injections generally keep the forced blinking component of my BEB under control, but the real problem I have is the constant heaviness of the eyelids and my inability to open my eyes even when there is no forced closing of the eyes. Dr Anderson explained that this condition is known as "apraxia of the lid opening" and that a percentage of BEB sufferers will also have apraxia. To test this, he had me squeeze my eyelids shut as hard as I could and then try to open my eyes. People who have apraxia will usually be unable to open their eyes for a few seconds following the hard squeezing. In my case, this did not happen. Dr Anderson explained that is quite common for people with BEB not to exhibit any symptoms while they are seeing him due to the fact that they somewhat "hyped up" or "wired" about their condition at the time. However, after a short while, I began to relax a little and my apraxia began to reappear. The Doctor witnessed this and confirmed that the condition was indeed apraxia.
Dr Anderson explained that apraxia cannot be treated with Botox because, if the central eyelid muscles are treated with Botox, the eyelids will droop. He went on to say that the only effective treatment for apraxia is a surgical procedure known as "Limited Upper Myectomy" which he developed 30 years ago. This procedure involves removing the majority of the closing muscles of the upper eyelids and leaving the opening muscles intact. This will ensure that the opening muscles have much more strength than the remaining closing muscles and therefore the ability to open the eyes in the majority of cases is restored. Dr Anderson has developed and refined the procedure over the past 30 years and now can perform the procedure in about 1 hour and also performs a cosmetic process to remove some of the loose eyelid tissue and reposition other tissue to "fill in" where the muscle has been removed so these regions do not appear hollow following the surgery. The doctor told us that he has performed this procedure thousands of times and now considers it to be minor surgery.
Dr Anderson went on to say that he prefers to do the procedure on one eye first, wait a couple of days and then do the other eye so his patients will be able to use one eye while the other is bandaged. He will do both eyes together if time constraints do not allow the procedure to be done on separately on each eye, but of course this will mean that the patient will have both eyes bandaged for a couple of days. It generally takes up to 6 weeks for normal vision to be restored following surgery.
Dr Anderson went on to say that in a small number of cases, the Myectomy does not improve the apraxia symptoms significantly and a follow-up procedure to insert a prosthetic device known as a "Frontalis Sling" can be carried out.
In my opinion, the myectomy, as with any other surgical procedure, should only be carried out as a last resort and in my case, I do not feel that my symptoms are severe enough at this time to warrant considering having the procedure done. However, I now have a lot of important information which will assist me in making the decision sometime in the future.