Minimal orbicularis oculi myectomy for treatment of severe benign essential blepharospasm: A case report

Abstract

Benign essential blepharospasm (BEB) is a type of focal dystonia characterized by excessive, involuntary, repetitive contractions of the orbicularis oculi muscle. In severe cases, the spasms can lead to functional blindness. The most effective and commonly employed treatment option for BEB is the use of botulinum neurotoxin A. However it is expensive and only provides temporary relief of symptoms. We report the case of a 60-year-old woman who presented to our center with complaint of inability to open her eyes of 6 weeks duration. This was preceded by 7 months history of excessive blinking and increasing difficulty opening her eyes voluntarily. On examination, the eyelids were tightly closed and the protractor muscles (orbicularis oculi, procerus and corrugator muscles) were spastic. She was diagnosed of severe bilateral benign essential blepharospasm. She had bilateral minimal orbicularis oculi muscle myectomy (involving excision of 8 mm wide strip of the muscle which included the orbital, septal and distal part of the pretarsal orbicularis muscle) of the upper and lower eyelids leading to resolution of the muscle spasm and opening of the eyelids. At 14 months follow up, she remained free of symptoms. Minimal orbicularis oculi myectomy was effective in providing long term relief of blepharospasm in our patient. This may be a viable option for treatment of BEB in low-income countries like Nigeria.