Surgical Management of Essential Blepharospasm

Abstract

There are few conditions seen by the facial plastic surgeon as disabling as blepharospasm. The anguish and frustration felt by patients suffering from this disease are profound. Although many conditions treated by the facial plastic surgeon are amenable to surgical intervention, blepharospasm is unique in that the majority of patients will not go on to need surgical treatment. To that end, it is important to understand the natural course of the disease and the overall response of patients to medical treatments. Thus one can identify the best candidates for surgical intervention. Blepharospasm is a progressive involuntary contraction of the entire orbicularis oculi muscles (pretarsal, preseptal, and periorbital) and the procerus, depressor supercilii, and corrugator muscles (Fig. 1). The onset is usually spontaneous with the spasms being bilateral, intermittent, or persistent. Isolated spasm involving the orbicularis oculi, procerus, depressor supercilii, and corrugator muscles is termed essential blepharospasm. As many as 80% of patients exhibit dystonic movements of other facial, oral, mandibular, or cervical muscles and many patients with essential blepharospasm go on to develop such associated spasms. Appropriate medical and surgical treatment of blepharospasm requires a clear understanding of the clinical features and differential diagnosis of the condition [1–26].