Table 4.

Management of eyelid and visual dysfunction in PSP/CBS.

1. Pharmacologic therapy

a. BoNT injections recommended for blepharospasm/lid levator inhibition

i. EMG guidance not necessary or recommended

ii. Pretarsal injections only recommended for refractory cases

b. Improve tear volume

i. Artificial tears

1. Glycerin

2. Carboxymethylcellulose

3. Polyethylene glycol

ii. Preservative-free lubricants

2. Non-pharmacologic therapy

a. Eyelid crutches

b. Sensory trick eyewear frames

c. Prevent conjunctival drying with humidifiers, warm wet compresses, avoiding forced air ventilation, and protective eyewear

d. Binocular prisms

i. For gaze limitation, not for diplopia

ii. Use with caution during ambulation

e. Environmental modifications

i. Elevate dinner plate

ii. Remove loose rugs, low coffee tables, and children's toys from floors

iii. Follow dinner fork or finger down to target

f. Referral to ophthalmologist or neuro-optometrist for consideration of:

i. Measures to reduce inflammation related to drying

ii. Improve tear retention