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Blinking and Blepharospasm-Reply

Joseph Jancovik, MD
JAMA. 1983;249(22):3016. doi:10.1001/jama.1983.03330460016013.
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In Reply.—  We thank Dr Lamberts for his thoughtful comments.In our article, "Blinking and Blepharospasm," we concentrated on the mechanisms, diagnosis, and treatment of common neurological and ophthalmologic conditions that cause increased blinking and blepharospasm. Defective tearing is certainly one of the most important ocular disorders, causing eye irritation, increased blinking, and even blepharospasm. We agree with Dr Lamberts that the protective value of proper lacrimation in the normal maintenance of corneal epithelium cannot be overemphasized. Normal reflex tearing may be disturbed by local corneal disease (eg, herpes zoster keratitis), by a lesion in the pontine tegmentum, where the preganglionic sympathetic fibers arise, in the sensory root (nervus intermedius) of the facial nerve, in the greater superficial petrosal nerve or in the deep petrosal nerve, in the sphenopalatine ganglion (eg, nasopharyngeal tumors), and in the ophthalmic or maxillary branches of the trigeminal nerve. An interruption of the afferent or

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