Differential section of the seventh nerve as a tertiary procedure for the treatment of benign essential blepharospasm.

PURPOSE: To examine the efficacy of differential section of the seventh nerve in treatment of patients with blepharospasm refractory to botulinum toxin and eyelid protractor myectomy.

METHODS

A retrospective noncomparative interventional case series consisting of a cohort of 228 patients with benign essential blepharospasm followed from 1987 to 1997 in a university ophthalmic plastic surgery referral practice. Patients were treated with botulinum toxin injections, eyelid protractor myectomy, and differential section of the seventh nerve in stepwise fashion as needed for symptomatic control.

RESULTS

Thirty-four patients (15% of total) underwent eyelid protractor myectomy during this period. Eyelid protractor myectomy failed to control blepharospasm in 7 (21%) of these 34 patients, who then underwent differential section of the seventh nerve an average of 2 years after myectomy. Patients were followed up for an average of 36 months, with a success rate of 42% (3 of 7). The remaining 4 patients had repeat differential section of the seventh nerve with a 50% success rate, which brought the overall success rate from differential section of the seventh nerve to 71%. Lower eyelid ectropion requiring surgical repair complicated 27% of differential section of the seventh nerve procedures.

CONCLUSIONS

Differential section of the seventh nerve is a reasonable alternative in the treatment of patients who have persistent disability despite treatment with botulinum toxin injections and eyelid protractor myectomy.