Follow-up of patients with essential blepharospasm who underwent eyelid protractor myectomy at the Mayo Clinic from 1980 through 1995

Purpose: To determine the efficacy of eyelid protractor myectomy (subtotal excision of the orbicularis oculi, the corrugator supercilii, and the proce rus muscles) for the treatment of essential blepharospasm, and to evaluate the need for and the effectiveness of botulinum toxin (BT) injections in th ese patients. Methods: The medical records of all patients who underwent eyelid protracto r myectomy at the Mayo Clinic (Rochester, MN) from 1980 through 1995 were r eviewed. The Health Status Questionnaire(R) was used to assess overall medi cal and mental health, and a questionnaire specific to eyelid spasms was de veloped. Results: Fifty-four white patients, of whom 32 (59%) were women, underwent myectomy. The average age at diagnosis of essential blepharospasm was 64 ye ars (median, 65 years; range, 43 to 84 years), whereas the average age at t he rime of myectomy was 66 years (median, 66 years; range, 51 to 85 years). Of the 14 patients who were treated with BT injections before myectomy, th e average interval between the initial injection and surgery was 21 months (median, 20 months; range, 2 to 51 months). Patients who had been treated w ith BT injections before myectomy were more likely to receive injections po stoperatively than were those patients who had not been treated with BT (p< 0.001). Twenty patients were treated with BT injections after myectomy; the overall probability of receiving BT five years after surgery was 46%. Time from myectomy to treatment with BT varied considerably: mean, 880 days; me dian, 659 days; range, 3 to 4221 days. Postoperative follow-up for those pa tients who did not receive BT after myectomy ranged from 2 to 5935 days (me an, 2354 days; median, 1722 days). Although the probability of receiving BT injections after myectomy was not associated with age or sex, there was a significant association with the time interval during which the myectomy ha d been performed (related to the availability of BT as an adjunctive therap y). Of the 41 patients who were alive when the study was conducted, 32 (78% ) completed a follow-up survey. Thirty of those (94%) said myectomy provide d shortterm and long-term benefits. Of the 11 patients who received BT inje ctions before and after myectomy, six (55%) said the toxin was more effecti ve in ameliorating eyelid spasms after surgery and four (36%) required inje ctions less frequently after myectomy. Results from the Health Status Quest ionnaire(R) showed no significant differences between patients who underwen t myectomy and control subjects. Conclusions: Eyelid protractor myectomy provides subjective benefit to pati ents with essential blepharospasm and decreases the long-term need for BT i njections in approximately 50% of these patients. Although the probability of receiving postoperative BT paralleled its availability, patients who rec eived both preoperative and postoperative BT perceived either increased eff icacy of the toxin injections, longer-lasting effects, or both, after myect omy. Patients with severe disability from blepharospasm benefited more from myectomy than did patients with relatively mild symptoms.