Minimal Orbicularis Myectomy: Does it Relieve Spasms in Benign Essential Blepharospasm?

Abstract

Introduction: A new technique of minimally invasive orbicularis myectomy is described. A study is presented to show its efficacy in relieving spasms in benign essential blepharospasm and to note any complications resulting from it. Materials and Methods: In a prospective clinical, interventional study conducted at oculoplastics department of a tertiary care center, 25 consecutive cases (50 eyes) of benign essential blepharospasm were included, from January 2012 to December 2014. The patients consisted of 19 women and 6 men between the ages 28 and 66 years (mean age, 52 years). After a thorough history, a complete ophthalmological examination, and assessment of functional disability, they received appropriate therapy for triggering factors such as dry eyes, meibomitis, blepharitis, and trachoma for 1 month, after which a minimal orbicularis myectomy of both the upper and lower lids was performed simultaneously under local anesthesia by a single surgeon. The cases were followed up after 1 week, 1 month, 3 months, 6 months, and 1 year. Results: Six cases (24%) needed simultaneous brow suspension; 4 cases (16%) had blepharoplasty for dermatochalasis. Postoperatively, ecchymosis of lids was noted in 13 cases (52%) and lid swelling in 3 cases (12%). No lad lag, lid asymmetry, or corneal exposure was seen in any case. Three cases needed frontalis suspension for apraxia of upper lids, which was done 1 month postoperatively. Patient satisfaction was 100%, with improved functional disability. Conclusion: Minimal orbicularis myectomy was found to be effective in providing a long-term relief of spasms and was not associated with any complications. However, proper patient selection is mandatory.