Essential blepharospasm is a chronic spasm condition of the eyelids that has no known cause, but it does the potential to cause functional visual blindness and severe disability. Symptoms are quite variable from patient to patient and over time within the same patient. The spasms can be so severe that affected patients may not be able to open their eyes to perform regular activities of daily living: driving, reading, working, and walking. A subset of blepharospasm patients also have apraxia of eyelid opening, wherein they experience a sustained “clamping” shut of their eyelids and have to struggle to get them to open again.
Dr. Burroughs and colleagues presented at the annual 2012 ASOPRS spring meeting the largest series of patients treated by a specialized technique for treating pseudo-apraxia of eyelid opening associated with blepharospasm.
This study showed both the safety and efficacy of treating this condition with botulinum toxin injections and that the incidence of ptosis (droopy eyelid) is extremely rare when performed as Dr. Burroughs and colleagues described. By definition, benign essential blepharospasm affects both eyes, but it can have variable presentations in different patients and change over time. Some patients also have spasms of their lower face (Meige syndrome) and other associated dystonias (neck and shoulder spasms). Hemifacial spasm is a different condition that affects only one side, but 5% of patients can have bilateral hemifacial spasm. A small percentage of patients with hemifacial spasm may have a serious brain aneurysm, brain vessel abnormality, or tumor that is the cause of the overly stimulated 7th cranial nerve-induced facial spasms. Dr. Burroughs has been treating patients with facial spasms issues since 1996.
Botulinum toxin (“Botox”) is the mainstay treatment for facial spasm issues. It works by blocking the release of acetylcholine at the neuromuscular junctions of the affected areas. Botox works within a few days of administration by very small needle injections, and it is temporary and reversible over time. Most patients achieve 3-6 months of improvement of their spasms, which enables them to resume normal activities such as driving, reading, and working. Dr. Burroughs has taught and presented at national symposia both standard and advanced injection techniques. Dr. Burroughs collaborated with some other physicians on a study demonstrating the effectiveness and safety of Botox injections for apraxia of eyelid opening. Dr. Burroughs is considered a “master-injector,” and is often referred some of the most difficult cases from both within Colorado and the surrounding states.
Rarely, Botox injections may become less successful over time, and Dr. Burroughs can then perform advanced surgical techniques to improve severe facial and eyelid spasm disorders. Dr. Burroughs trained under the pioneer of myectomy (eyelid muscle removal) surgeries, which is sometimes required for patients with the most severe forms of this condition. This is a very serious oculoplastic surgery that many surgeons don’t perform because of inadequate experience, training, or understanding of how to perform the surgery safely and well. Dr. Burroughs has performed myectomy surgeries since 2004 and receives patients from throughout Colorado and other parts of the nation. The Benign Essential Blepharospasm Research Foundation (BEBRF) has a very useful website and newsletter.