Southwest, FL | Case of the Day-Blepharospasm | Cataract & Refractive Institute of Florida

Dr. Croley describes a case of benign essential blepharospasm in where a patient's face goes into spasm. It is usually bilateral and is slightly different from hemifcial spasm which is usually unilateral. These spasms are usually treated with Botox.


Dr. Croley: Hello and welcome to case of the day. I'm Dr Croley. And today we're going to discuss an interesting case.

Dr. Croley: A lady came in today, elderly and her seventies, late seventies who complains of one side of her face going into spasm. What she had was hemifacial spasm. Which is a complex of other things, also called benign essential blepharospasm.

Dr. Croley: These entities happen and there are dystonic contraction of the muscles. Typically we're talking about around the face. This lady's left side of her face would go into spasm and sometimes this spasm is very painful. If you have it bilaterally, which is usually what benign essential blepharospasm is bilateral, then both eyes can squeeze shut. If you're driving down the highway, that's a huge problem.

Dr. Croley: Benign essential blepharospasm has been studied for years. In the beginning, way back many years ago, people thought all these people were crazy. They needed to be put on psychotropic drugs and tranquilizers and all these things and none of those things stop the spasm.

Dr. Croley: When I was a resident many years ago, I trained in a hospital where we were one of the few hospitals in the United States and even in the world who actually treated the spasm. In those days we actually made an incision in front of the ear all the way down and dissected out across the face, all the muscles that come across that stimulate the muscles in your face. And we would diagram what muscles were going into a spasm before surgery. And then we would dissect out and isolate all the branches of the facial nerve that supplies information to the muscles in the face. Then we would take a little stimulator and tap the different branches to see which one led to where the muscle was going into spasm. You would actually cut that nerve and take a piece of the nerve out so the ends could not touch to then maybe try to grow back together.

Dr. Croley: That was before there was Botox, that was how we treated blepharospasm. You had to be very careful because this is permanent. So you don't want to cut something and paralyzed part of someone's face where they'd have trouble chewing or something would happen. So you had to be very delicate about what we did.

Dr. Croley: Then after my residency, then the Botox came out, which is botulinum toxin and Botox paralyzes the muscles. The great thing about Botox is it works really well. Also if something is overdone, then the Botox then wears off, which is also a bad thing about Botox because you have to keep giving injections.

Dr. Croley: So today's treatment of essential blepharospasm is actually giving Botox injections, an area where the spasms going on. That's what we did for this lady today. We gave her a Botox injections because she was having a spasm all the way down to the muscles in her neck. And so this is, like I said, one it's very socially embarrassing. Two, it's uncomfortable. And three, if it's happening to both sides, you can't see until the spasm goes away.

Dr. Croley: This is different from someone's eyelid twitching a little. This is not the same as your eyelid twitches a little bit. This is actually a spasm. There are still some doctors today, if the spasm stays around the eye who will go in and sort of like doing a blepharoplasty where we go in and take the extra skin out and take a little strip of muscle at the same time these doctors are going in and taking a lot of the muscle out that's going into spasm so you don't have the spasm. So there are still some few isolated centers around the country who are doing myectomies; that is taking that piece of the muscle out for treatment of blepharospasm.

Dr. Croley: But really the essential treatment is Botox injections. The thing is you have to have the injections every four or five months to keep repeating those because it wears off.

Dr. Croley: It's an unusual disease. There's actually an essential blepharospasm society. There's a website because these people have been so miserable for a lot of their life that they've actually banded together and have an organization.

Dr. Croley: The other thing that some people even try to do who have their spasms is they wear glasses and they put little pieces of metal across their glasses to keep their lids up so they won't squeeze closed, not very comfortable to wear, but if they're having that much trouble, they're actually wearing glasses. But there's a little device that goes across to keep their lids from closing all the way.

Dr. Croley: So anyway, that's just an interesting lady. We do have treatment now with the Botox, and so she does very well with those. That was today's case of the day. If you have any questions about that, please contact us through the website and I may God bless you with healthy eyes and great vision.