From Injections to the Operating Table: Surgical Management of Blepharospasm or Hemifacial Spasm

吳淑雅 Shu-Ya WuTaiwan Speaker From Injections to the Operating Table: Surgical Management of Benign Essential Blepharospasm Benign essential blepharospasm (BEB) is an adult-onset focal dystonia characterized by involuntary spasms of the periocular muscles, resulting in forced eyelid closure. Because the pathogenesis of BEB remains unclear, current management primarily aims at symptomatic relief. Botulinum toxin injection remains the first-line therapy, while surgical intervention is considered for patients with poor response to injections, or for those with eyelid deformities secondary to blepharospasm. Protractor myectomy can be performed as either a full or limited procedure. Currently, limited myectomy is preferred due to its superior cosmetic outcomes and lower complication rates. In addition, combining limited myectomy or eyelid corrective surgery with botulinum toxin injections can further optimize clinical outcomes. Apraxia of eyelid opening (AEO) is characterized by the paradoxical co-contraction of the orbicularis oculi and levator palpebrae muscles, often necessitating surgical management. Surgical strategies may involve either a single-stage or a two-stage approach. I personally favor the two-stage approach, as performing all procedures simultaneously can be technically challenging due to a higher risk of bleeding and hematoma formation. Staging the procedures allows for adequate assessment of the initial surgical results and more precise planning of subsequent interventions.