What it means for a patient
- Blepharospasm is uncontrolled, forceful closing of the eyelids.
- Long-term spasm stretches the brow and eyelid tissues, which leads to drooping brows, excess eyelid skin and a droopy upper lid.
- This operation removes the muscles that close the eyelids and pull the brows down, and it lifts the brow and repairs the lid in the same surgery.
- The authors state it avoids the facial paralysis linked to nerve-cutting surgery.
- Limits: 15 patients, no comparison group, and no outcome numbers in the abstract.
Why this paper matters
It described removal of the eyelid-closing muscles combined with brow and levator repair as a surgical treatment for essential blepharospasm.
Overview
Essential blepharospasm is a disease of unknown cause in which the eyelids close forcefully and repeatedly; the authors describe it as progressively disabling and leading to blindness. Years of spasm cause drooping brows, excess eyelid skin, and often defects in the lid-lifting tendon and the outer corner tendon. Standard surgery cuts facial nerve branches (neurectomy), and afterward these problems worsen and the face droops.
Findings
- Years of forceful spasm cause brow ptosis, dermatochalasis, and often defects of the levator aponeurosis and lateral canthal tendon.
- After standard neurectomy, facial droop, brow ptosis and dermatochalasis worsen, and ptosis and canthal tendon laxity suddenly become more evident.
- The procedure removes all accessible orbicularis oculi, procerus and corrugator supercilii muscle, and the facial nerve branches in the postorbicular fascia.
- Removal of these eyelid protractors is combined with a browplasty fixed to the frontalis, and reinforcement of the levator aponeurosis to strengthen the retractors.
- The authors report the technique opens the eye as effectively as standard facial neurectomy.
- It also corrects the associated anatomic deformities at the same time and avoids facial paralysis.
- Results are reported in 15 patients followed for 6 to 38 months.
- The abstract gives no measured outcomes or complication rates.
Terms
- Essential blepharospasm: forceful, involuntary closing of both eyelids with no known cause.
- Idiopathic: of unknown cause.
- Dermatochalasis: excess, loose skin of the eyelids.
- Brow ptosis: drooping of the eyebrow.
- Levator aponeurosis: the tendon-like sheet that lifts the upper eyelid.
- Lateral canthal tendon: the tendon that anchors the outer corner of the eyelids to bone.
- Neurectomy: surgical cutting or removal of a nerve.
- Protractors and retractors: the muscles that close the eyelids, and the muscles that open them.
- Orbicularis oculi, procerus and corrugator supercilii: muscles around the eye and between the brows that close the eye and pull the brows down.
- Browplasty: surgery to lift and fix the brow.