As we grow older, it is normal to experience age-related eye problems. These changes usually have nothing to do with Parkinson’s. If you are having vision problems, it is important to visit an ophthalmologist first.
Vision Changes in Parkinson’s
There are some vision changes that may be due to Parkinson’s or medications for PD:
- Double vision can occur due to medications or because the eyes have trouble working together, also called convergence insufficiency. Special prism glasses can correct this.
- Parkinson’s can cause dry eyes and decreased blinking.
- PD medication, especially anticholinergics, can cause blurry vision. If you take anticholinergic medication [such as trihexyphenidyl (formerly Artane®) and benzotropine (Cogentin®)], read this important information about the relationship between this type of medication and dementia.
Uncommon Vision Conditions
It is not common for people with Parkinson’s disease to experience involuntary closure of the eyes, but it does occur in some cases. This phenomenon has been referred to as blepharospasm, pronounced 'blef-a-ro-spaz-m'. “Blepharo” refers to the eyelid, and “spasm” is defined as an uncontrollable muscle contraction.
There are many conditions that can cause involuntary eye closure, and these conditions are not related to Parkinson’s disease. They include the following:
- An inflammatory eye condition due to an infection or an allergy
- Dry eyes
- Damage to the surface of the eye
- Ptosis (when a person’s eyelid appears to be “drooping.” It can be caused by muscle weakness, nerve damage, or looseness of the eyelid skin. This is often associated with normal aging.)
- Other conditions
If the ophthalmologist determines that the conditions above do not account for the eye closure, the next step is to see your neurologist to determine if the problem is related to the doses of your PD medications.
If eyelid closure remains a problem after medications have been optimized (optimizing your medications refers to a process in which you and your doctor work to find the medication regimen from which you derive the greatest benefit), then injection of botulinum toxin, also called botox, every 3-4 months in the muscles around the eyelids has been found to be a very effective treatment.
In rare cases, botulinum toxin may be ineffective, and it may be helpful to consult a movement disorder specialist (MDS), a neurologist with expertise in movement disorders like Parkinson’s disease. An MDS can help determine whether the diagnosis is correct. Sometimes blepharospasm can be confused with another condition called “apraxia of eyelid opening.”