blepharoplasty A surgical OPERATIONto remove
excess tissue from the eyelids to correct drooping
upper eyelids and “baggy” lower eyelids. Such
conditions most commonly develop as a conse-
quence of aging or extensive weight loss or when
there is damage to the nerves that control the eye-
lid muscles (such as with PARKINSON’S DISEASE). An
ophthalmologist or a plastic surgeon performs ble-
pharoplasty, usually as an AMBULATORY SURGERY
(also called outpatient or same-day surgery).
Recovery takes two to four weeks; there can be
significant swelling, bruising, and discoloration
especially during the first two weeks after the
operation. Cold compresses help reduce these
symptoms. The risks of blepharoplasty include
excessive bleeding and INFECTION.
See also BLACK EYE; BLEPHAROSPASM; PLASTIC SUR-
GERY; PTOSIS; RHINOPLASTY; RHITIDOPLASTY; SURGERY
BENEFIT AND RISK ASSESSMENT.
blepharospasm Involuntary closure of the eyelid
that results from dysfunction of or damage to the
nerves that control the muscles of the eyelids.
Episodes of closure may range from brief (a
minute) to extended (several hours). Extended
closure interferes with vision. Doctors do not
know what causes blepharospasm, though it is a
symptom of numerous neurologic and neuromus-
cular disorders that affect MUSCLEcontrol such as
PARKINSON’S DISEASEand DYSTONIA. Blepharospasm
that develops without an apparent underlying dis-
order is benign essential blepharospasm. Ble-
pharospasm often begins with minor twitches and
tics or squinting, progressing over time to forceful
and prolonged contraction of the eyelid muscles.
PHOTOPHOBIA (sensitivity to light) is common.
Fatigue and CAFFEINE may initiate episodes of
spasms.
The diagnostic path may include a NEUROLOGIC
EXAMINATION to determine whether underlying
neurologic disorders exist. Blepharospasm requires
treatment when it begins to interfere with the
activities of everyday life. Moderate ble-
pharospasm often responds to MUSCLE RELAXANT
MEDICATIONS such as clonazepam (Klonopin) or
Lioresal (Baclofen), or to medications used to treat
Parkinson’s disease such as levodopa. Many peo-
ple obtain long-term relief from injections of botu-
linum toxin, which temporarily paralyzes the
eyelid muscles. Surgery to remove muscle tissue
(myectomy) or to cut the nerves supplying the
eyelid muscles (neurectomy) may provide relief.
Though therapeutic measures can control symp-
toms, as yet there is no cure for blepharospasm.
See also BOTULINUM THERAPY; PTOSIS; SURGERY BEN-
EFIT AND RISK MANAGEMENT; TIC.blindness See VISION IMPAIRMENT.braille A tactile (touch-based) system of written
language that features patterns of raised dots to
represent letters of the alphabet, common words
and contractions, mathematical symbols, and
punctuation. Named after its developer, Louis
Braille (1809–1852), braille allows people who are
blind to read and, with adaptive typewriters and
computer technology, to write. Six dots, in two
columns of three dots each, form the foundation
for braille; the presence or absence of dots in spe-
cific patterns identifies the letter, number, symbol,
or concept. There are a number of braille varia-
tions, or codes, in common use in the United
States. The major ones are these:- American literary braille code uses about 250
patterns to create book-length materials using
short-form words, contractions, single-cell
words, and symbols; patterns may have multi-
ple meanings interpreted by context. - Grade 2 braille code is an abbreviated variation
of American literary braille code used primarily
for recreational reading materials such as nov-
els and nonacademic nonfiction. - Grade 1 braille code is the basic alphabet and
numerals 0 through 9. - Nemeth braille code contains about 600
unique, specialized patterns that are distinct
from American literary braille code for use in
mathematics and science. - Computer braille code provides a mix of Ameri-
can literary braille code, Nemeth braille code,
and unique symbols for computer program-
ming and instruction documentation. - Music braille code is specialized for transcribing
musical scores.
braille 75