Management of Essential Blepharospasm: Botulinum Toxin A Treatment and Orbicularis Myectomy Operation

Lee, Hyun Dong; Jang, Jae Woo; Lee, Sang Yeul

Abstract

To investigate results of treatment with essential blepharospasm, patients were evaluated by results of treatment with botulinum toxin A and myectomy operation. Seventy patients of the essential blepharospasm who received local injection of botulinum toxin or orbicularis muscle extirpative surgery were evaluated according to results and complications of the treatment modality over a 7-year period. Fifty-six patients[80%] were primarily treated with botulinum toxin and 14 patients[20%] underwent myectomy operation as the primary treatment. Of the 56 patients, 8[14.3%] were treated later with myectomy operation. In botulinum toxin treatment, the mean subjective improvement was found in 89.2% of the patients, and the mean effective durations of essential blepharospasm were 12.7 weeks. Severity and frequency grades in eyelid spasm were significantly lower after injection[P=.000]. Tearing, dry eye, and headche were the most frequent complications and ptosis was observed in 2 cases[2.0%]. In the orbicularis myectomy operation, 13 patients[59.1%] were carried out through a brow incisions, 1[4.5%] through a blepharoplasty incisions, and 8[36.4%] through both. Fourteen patients[63.6%] had acceptable control of blepharospasm throughout follow-up after the upper lid orbicularis stripping procedure alone. We believe that botulinum toxin is the treatment of first choice because of its higher acceptance rate. Surgery is reserved for botulinum toxin failure. In otherwise fit patients, myectomy is the treatment of first choice.