What is the role of surgery in the treatment of benign essential blepharospasm (BEB)?

Updated: May 20, 2019
  • Author: Robert H Graham, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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In patients with blepharospasm who do not develop sufficient improvement with an adequate trial of botulinum toxin injections, surgical intervention may be considered. The mainstay of surgical treatment of spasm of the orbicularis oculi is myectomy. [57, 58, 59, 60, 61, 62] An older procedure, neurectomy, has almost completely been abandoned because of a higher complication rate than seen with myectomy. Many patients with BEB have a component of apraxia of eyelid opening. [63, 64] It is estimated that almost 50% of patients who are considered failures of BOTOX® treatment have apraxia of eyelid opening. Frontalis suspension and limited myectomy with complete removal of the pretarsal orbicularis should be considered for patients who are visually disabled by apraxia of eyelid opening.

Patients may fail botulinum toxin therapy because they have eyelid malposition, aesthetic concerns, apraxia of eyelid opening, or photo-oculodynia. These conditions require surgeries in addition to or in place of myectomy.

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