Operation for Blepharospasm.

BLEPHAROSPASM is an involuntary spasmodic but tonic contraction of the orbicularis oculi that may last a few seconds to a few minutes spaced by periods of relaxation. It tends to become progressive and bilateral and is often associated with spasms of other muscles innervated by the facial nerve. It is difficult to treat and is not subject to spontaneous resolution. The usual medical remedies (derivatives of belladonna, antiparkinsonian drugs, amphetamine, benzedrine, muscle relaxants, sedatives, hypnotics, etc.) have little or no effect, require prolonged administration, and are often badly tolerated because of side-effects. Physiotherapy and psychotherapy have not been found successful. Surgical treatment is more promising, but the effects of weakening the orbicularis muscle or interfering with the facial nerve at different levels are usually only temporary and may be followed by unpleasant complications. The whole subject has been reviewed in detail by Henderson (1956). In a patient who had been given many forms of treatment without success we have used a surgical method which is efficient, simple to perform, has no secondary effects and offers a key to the pathogenesis of some forms of blepharospasm hitherto regarded as idiopathic.