The effect of bangerter occlusion foils on blepharospasm and hemifacial spasm in occlusion-positive and occlusion-negative patients

Abstract

Objective: To test the hypothesis that occlusion-positive (OP) patients with blepharospasm (BEB) or hemifacial spasm (HFS) will benefit from a Bangerter occlusion foil (BOF), compared to occlusion-negative (ON) patients. OP/ON was based on immediate improvement in spasm with placement of a hand in front of either eye.

Design: Prospective non-randomised single-centre pilot study.

Participants: Fifteen-patients (6 BEB, 9 HFS).

Methods: Patients were identified as OP or ON and wore highest-density BOF tolerable over one spectacle lens for 1 month. Outcomes were assessed at 1 month.

Main outcome measures: Validated quality-of-life questionnaire (CDQ-24), scores of blink-rate and spasm severity assessed by two observers from video-recordings.

Results: OP group had mean improvement in all scores. There was no change or worsening of scores in the ON group. In both BEB and HFS, more OP patients reported subjective benefit from wearing a foil (2 of 4 BEB, and 2 of 2 HFS) compared to the ON group (0 of 2 BEB, and 1 of 7 HFS).

Conclusion: OP patients with BEB and HFS are more likely to experience improvement in spasms from wearing a BOF compared to ON patients. The occlusion test should be considered on all patients with BEB or HFS.

Keywords: Essential blepharospasm; bangerter occlusion foils; occlusion test..

Fig (1).

(a, b) Occlusion test is performed with patient’s hand placed 3cm in front of the ipsilateral eye, avoiding facial or spectacle contact. (c) The Bangerter occlusion foil is a disposable self-adhesive foil, which can be cut to size to fit over a spectacle lens. 0.8 density foil shown here. (d) Bangerter occlusion foil (0.2 density) placed over right spectacle lens.