Blepharospasm - Treatment

What is Blepharopasm?

Treatment Options for Blepharospasm

General Management of Blepharopspasm

Medical Treatment of Benign Essential Blepharospasm

Surgical Treatment of Benign Essential Blepharospasm

Surgical treatment is considered only when there is poor response to a completed trial of Botox Injections. Spasm of the orbicularis oculi is best treated with myectomy. Frontalis suspension and limited myectomy with complete removal of the pretarsal orbicularis is preferred for patients who are visually disabled by apraxia of eyelid opening.

1.    Myectomy

Myectomy is done in stages starting with upper eyelid surgery, followed by the lower eyelid surgery if symptoms persist. Chronic lymphedema is a common complication of simultaneous upper and lower eyelid myectomy, hence it is avoided. Myectomy might be limited myectomy or extended myectomy.

Limited myectomy: Consists of surgical extirpation of eyelid protactors, including pretarsal, preseptal, and orbital portions of orbicularis oculi muscle.

Extended myectomy: In adds to to the above, it involves removal of the procerus and corrugator muscles.

2.    Superior Cervical Ganglion Block

For patients who complain of debilitating light sensitivity (photo-oculodynia) intervention by a pain clinic might be beneficial to the patient. Superior cervical ganglion blocks reduce photo-oculodynia by chemical denervation of the orbital sympathetics, thus numbing the afferent loop of the disease and providing symptom relief.



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