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. 2017 Nov 5;23(4):8-12.
doi: 10.5693/djo.01.2016.11.001. eCollection 2017.

Surgical approach to limiting skin contracture following protractor myectomy for essential blepharospasm

Jeremy Clark  1 , John Randolph  1 , Jason A Sokol  2 , Nicholas A Moore  3 , Hui Bae H Lee  3 , William R Nunery  1   3
Affiliations

Surgical approach to limiting skin contracture following protractor myectomy for essential blepharospasm

Jeremy Clark et al. Digit J Ophthalmol. .

Abstract

Purpose: To report our experience with protractor myectomy in patients with benign essential blepharospasm who did not respond to serial botulinum toxin injection, and to describe intra- and postoperative techniques that limited skin contracture while also providing excellent functional and cosmetic results.

Methods: The medical records of patients with isolated, benign, essential blepharospasm who underwent protractor myectomy from 2005 to 2008 by a single surgeon were reviewed retrospectively. The technique entailed operating on a single eyelid during each procedure, using a complete en bloc resection of all orbicularis tissue, leaving all eyelid skin intact at the time of surgery, and placing the lid under stretch with Frost suture and applying a pressure dressing for 5-7 days.

Results: Data from 28 eyelids in 7 patients were included. Average follow-up was 21.5 months (range, 4-76 months). Of the 28 eyelids, 20 (71.4%) showed postoperative resolution of spasm, with no further need for botulinum toxin injections. In the 8 eyelids requiring further injections, the average time to injection after surgery was 194 days (range, 78-323 days), and the average number of injections was 12 (range, 2-23 injections). All but one eyelid had excellent cosmetic results, without signs of contracture; one eyelid developed postoperative skin contracture following premature removal of the Frost suture and pressure dressing because of concerns over increased intraocular pressure.

Conclusions: In our patient cohort, this modified technique resulted in excellent cosmetic and functional results and limited postoperative skin contracture.

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Figures

Figure 1
Figure 1
Surgical technique of protractor myectomy. A, The upper eyelid protractor muscles are approached through a lid crease incision. B–C, The orbital, preseptal and pretarsal divisions of the orbicularis are removed en bloc, exposing the base of the underlying eyelashes. D, Frost suture is applied to the eyelid in the immediate postoperative period.
Figure 2
Figure 2
Demonstration of improvement of blepharospasm after protractor myectomy. A, Preoperative photograph showing severe blepharospasm. B, Marked improvement 6 months after bilateral upper and lower eyelid myectomy surgery.
Figure 3
Figure 3
Demonstration of postoperative skin contracture. A, Preoperative picture demonstrating severe blepharospasm that was unresponsive to serial botulinum toxin injections. B, Improvement of blepharospasm 3 months following bilateral upper and lower eyelid myectomy surgery. C, The right upper eyelid developed postoperative contracture following premature removal of Frost suture and pressure dressing 2 days after surgery.
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