Clinical doxorubicin chemomyectomy. An experimental treatment for benign essential blepharospasm and hemifacial spasm.

Doxorubicin (DXR) was injected as a treatment for benign essential blepharospasm and hemifacial spasm. The other eyelids were treated concurrently with botulinum toxin (BT). No DXR-treated eyelid has maintained 0 strength (commonly achieved with BT). Two patients with benign essential blepharospasm and four patients with hemifacial spasm have achieved major improvement, sustained for more than 6 months. Eyelids have been swollen and inflamed for up to 3 months. No spontaneously irreversible complication has occurred. A single injection at the maximum safe dose (1 mg in the upper lid and 1.5 mg in the lower lid) has not proven sufficient to produce cure. Treatment of each lower eyelid of a muscular male with severe blepharospasm may require cumulative doses of up to 4.0 mg, delivered in three injection events separated by at least 2 months, with each injection no greater than 1.5 mg DXR per site. At the present time, there is no assurance that a permanent cure will result.