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Manual lifting of the eyelid often resolves the problem and the lid is able to stay open. ALO was first clearly described as a distinct entity in 1965 as "a nonparalytic motor abnormality characterized by the patient's difficulty in initiating the act of lid elevation present only momentarily at the start of lid opening."
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The distometer is held against the ocular side of the frame, at the middle of the upper eyewire. Measurements are then taken from the deepest point under the eyelid, up to where it meets the overhang of the eyewear's eyewire. [4] Most measurements come in between 15 and 20 millimeters, but extended or reduced lengths may occur too. [5]
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Blepharospasm usually begins with occasional twitches of both eyelids, which progress over time to forceful and frequent spasms and contractions of the eyelids. In severe episodes, the patient cannot open their eyelids (apraxia), which severely limits their daily activities. Prolonged closure of the eyelids may result in functional blindness. [4]
The NHS treatments blacklist is an informal name for a list of medicines and procedures which will not be funded by public money except in exceptional cases. These include but are not limited to procedures which the National Institute for Health and Care Excellence (NICE) has ruled of limited effectiveness and particular brand name medicines.