What is Blepharospasm?
Essential Blepharospasm or Benign Essential Blepharospasm is the medical name for a neurologic condition which causes bilateral (both eyes) involuntary eyelid closure. Although the cause is completely different, hemifacial spasm is a medical condition that causes unilateral facial twitching, which can be very visually bothersome.
Both of these conditions cause involuntary contraction of facial muscles. Treatment of both can involve a number of techniques, including biofeedback and relaxation techniques, oral drug therapies, and surgery. In most patients, however, the treatment of these conditions is a careful Botox treatment to the muscles of the upper face.
Treatments for these conditions are generally considered to be medically necessary and are covered by Medicare and other insurance plans. If you experience bothersome eyelid twitching or involuntary closure of your eyelids, you may be an excellent candidate for Medical Botox Treatment in St. Louis to correct essential blepharospasm or hemifacial spasm.
Causes and Characteristics of Blepharospasm and Hemifacial Spasm
Essential Blepharospasm is a form of involuntary movement disorder called a dystonia. Dystonias are characterized by involuntary twisting, pulling, or squeezing movements. The usual age of onset is in the mid-60s, although this can vary greatly.
The cause is generally believed to be an acquired imbalance in the activity of brain cells at involuntary levels deep in the brain. Both sides of the face are usually involved with essential blepharospasm, although one side is often more severe.
The cause is frequently what is called Meige’s syndrome or oromandibular dystonia. Some patients have a generalized dystonia or progress to a neck spasm called spasmodic torticollis, voice box spasm, or spasmodic dystonia.
Anxiety, bright lights, other eye irritations, and specific activities can trigger the involuntary blinking or eyelid closure. Looking down, lifting a trigger point such as an eyebrow, whistling, singing, or humming can often relieve the eyelid spasm.
Hemifacial spasm has a different character than essential blepharospasm, as a generally one-sided, intermittent, high frequency contracture of the facial muscles. The cause is believed to be a blood vessel that compresses the facial nerve as it exits the brain. Although it can be treated with a neurosurgical procedure to decompress the nerve within the brain, this treatment also carries some severe risks, so only a few patients tend to pursue it.
Oral medications and other techniques are seldom used anymore, as few patients achieve relief from these. As previously mentioned, the most effective treatment for 95% of patients with this condition is Botox.
Botox Treatment for Blepharospasms
95% of patients with Essential Blepharospasm and Hemifacial Spasm benefit from treatment with botulinum A toxin (Botox) injected into the affected muscles. The Botox is injected right into the problem muscles, essentially relaxing them and preventing them from spasming. Most of our patients receive a topical anesthetic cream specific to our practice which relieves the tiny needle-prick involved.
The Botox treatments last for 2-6 months, with a need to return for more treatment after that time. Medicare and other health insurance carriers generally cover these treatments on a medically necessary basis. Read more about Botox.
Side effects of Botox include the desired weakening of the eyelid muscles. This may interfere with eyelid closure and even normal blinking for a few weeks, requiring the increased use of artificial tear drops and lubricant ointments. Occasionally, patients develop a droopy eyelid or slight droop in the face which lasts a few weeks. Since the Botox treatment is not a permanent solution, the side effects are also temporary.
Another treatment for Blepharospasm is a surgical procedure called a Myectomy, in which the muscles that are in spasm are removed. This is a very intricate surgery that must be performed by experienced surgeons like those at Ophthalmic Plastic and Cosmetic Surgery, Inc. in St. Louis.
Fortunately, Dr. Holds has over 20 years of experience in treating thousands of patients with essential blepharospasm and hemifacial spasm. He has researched this disease, written multiple medical papers about it, and has taught courses to other physicians and patients regarding these treatments. He has a referral base for these patients which extends nationally, and he is recognized as a well-known authority in the treatment of these conditions.
Myectomy Surgery Procedure
Myectomy is performed as an outpatient surgery under a sedated local anesthetic, and it takes a few hours. During the procedure, the surgeon removes all or a portion of the muscle that is causing the spasm or eyelid closure problem. Most patients require simultaneous procedures to correct sagging skin, eyebrows, or eyelids. This surgery is complex and very specialized. A relatively small number of surgeons in the United States can appropriately perform this operation for essential blepharospasm.
Significant bruising, swelling, and soreness may develop after the anesthetic wears off. You can take pain medication, if necessary, and you will be asked to sleep with your head elevated and apply ice packs to your eyes periodically to keep the swelling down. You may also be given orders for eye drops or ointments to put in your eyes for one to two weeks.
Swelling tends to be significant with this surgery, and can take a few months to completely resolve. The bruising usually lasts no more than two weeks, but sometimes, it can last a bit longer.
Schedule a Consultation
Call our office today at 314-567-3567 if you are plagued with eyelid twitches or involuntary eyelid closures.