A total of 39 patients with
essential blepharospasm and 2 patients with
hemifacial spasm were treated with one or more forms of
therapy. All patients underwent neurologic and ophthalmic assessment to rule out ocular causes of
blepharospasm. Thirty-six patients were given a trial of various medications. Only one patient was successfully treated: her condition was markedly improved with
pimozide after
benztropine mesylate,
clonazepam and
amantadine hydrochloride had failed to help. Patients who did not respond to
drug therapy were offered the option of undergoing eyebrow-eyelid muscle stripping surgery. The six patients who underwent surgery showed considerable improvement; however, side effects such as frontal
anesthesia, exposure
keratitis, lagophthalmus,
scarring and eyelid malposition occurred, and three of the six had residual
spasm. At this point type A
botulinum toxin became available. A total of 27 patients (26 who did not respond to
drug therapy, including the 3 with residual
spasm after surgery, and 1 previously untreated patient) received type A
botulinum toxin injections. Most experienced rapid relief from their
spasms. The beneficial effects lasted weeks to months, and there were no major side effects. Treatment with type A
botulinum toxin appears to be a safe and effective means of temporarily relieving
blepharospasm. The long-term results with repeated
injections are yet to be determined.