Parkinson’s disease is a progressive neurological disorder that impacts movement. Some individuals experience noticeable eye closure. Understanding this symptom is important for those living with the condition and their caregivers, as it can significantly affect daily life.
Neurological Reasons for Eye Closure
Eye closure in Parkinson’s disease primarily stems from neurological issues affecting eyelid muscles and nerve signals. Two main conditions contribute: blepharospasm and apraxia of eyelid opening. These can occur independently or together, leading to varying degrees of involuntary eye closure.
Blepharospasm is a type of focal dystonia involving involuntary, sustained contractions of the orbicularis oculi muscles around the eyes. These contractions cause forced eye closure, making it difficult to keep the eyes open. Dystonia is a common non-motor symptom in Parkinson’s, often linked to dopamine dysregulation in the basal ganglia, a brain region involved in movement control. This can be a painful and debilitating condition, significantly impacting vision and daily activities.
Apraxia of Eyelid Opening (AOL) is characterized by difficulty initiating the voluntary act of opening the eyes, despite the eyelid muscles themselves not being weak. AOL is considered a problem with the brain’s “command” to open the eyes, a disruption in the neural pathways that coordinate voluntary eyelid movement. While blepharospasm involves involuntary muscle contraction, AOL is a problem with initiating movement, differentiating it from the forceful closure seen in blepharospasm.
Other Contributing Factors
While neurological mechanisms are primary, other factors can worsen eye closure in Parkinson’s, increasing its frequency or severity. These factors do not directly cause eye closure but can make the symptom more pronounced.
Dry eyes are a common issue for individuals with Parkinson’s disease, with studies indicating that over 60% report symptoms. This is often due to a reduced blinking rate, which is a common symptom of Parkinson’s. Reduced blinking allows tears to evaporate faster, leading to irritation and discomfort, which can naturally prompt eye closure for relief.
Increased sensitivity to light, known as photophobia, is another factor that can lead to eye closure. This sensitivity causes discomfort and glare intolerance, particularly in bright environments. To alleviate this discomfort, individuals may instinctively close their eyes.
General fatigue, a prevalent non-motor symptom in Parkinson’s, can also contribute to the difficulty of keeping eyes open. When a person is fatigued, maintaining voluntary muscle control, including eyelid elevation, can become more challenging. Additionally, cognitive or attention issues, which can occur in Parkinson’s, may further reduce spontaneous movements like blinking, indirectly contributing to the feeling of needing to close the eyes.
Addressing Eye Closure in Parkinson’s
Diagnosing the cause of eye closure in Parkinson’s relies on clinical observation and neurological examination to differentiate between blepharospasm and apraxia of eyelid opening. This distinction helps guide appropriate management strategies.
Management often involves a combination of approaches. For blepharospasm, botulinum toxin injections are a primary treatment. This neurotoxin works by blocking the release of acetylcholine, which causes muscles to contract, leading to temporary muscle relaxation. Injections are administered into the orbicularis oculi muscles around the eyes, reducing involuntary spasms and decreasing the frequency of blinking and uncontrollable closure. The effects typically begin within a few days and can last for approximately three to four months, requiring repeat treatments. Oral medications may also be considered, though they are often less effective for eye closure.
Non-pharmacological interventions are also important, particularly for managing contributing factors. Artificial tears can provide relief for dry eyes. Wearing sunglasses can help reduce discomfort for individuals experiencing photophobia. Managing general fatigue through appropriate rest and activity planning can also alleviate the tendency for eyes to close. Some individuals with blepharospasm find relief through “sensory tricks,” such as lightly touching the face or temples, which can temporarily reduce spasms and help open the eyes.
A multidisciplinary approach is highly beneficial in addressing eye closure and other Parkinson’s symptoms. This involves collaboration among various healthcare professionals, including neurologists, ophthalmologists, and therapists. Physical and occupational therapists can play a role in managing dystonia and improving daily function, helping individuals adapt to and cope with the challenges posed by eye closure.