Hello and welcome to Case of the Day. I’m Dr Croley and today we’re gonna discuss an interesting case. A lady came in today, elderly in her seventies, late seventies, who complains of her face, once have her face going into spasm. So what she had was a Hemifacial spasm, or which is a complex of other things, also called benign essential blepharospasm.
These entities happen in their dystonic contraction of the muscles and typically we’re talking about around the face. This lady’s left side of her face would go into spasm. Sometimes this spasm is very painful. If you have it bilaterally, which is usually what benign essential blepharospasm is, bilateral, then both eyes can squeeze shut. If you’re driving down the highway, that’s a huge problem.
Benign essential blepharoplasty has been studied for years. In the beginning, way back many years ago, people thought all these people were crazy, they need to be put in psychotropic drugs and tranquilizers and all these things and none of those things stopped the spasm.
When I was a resident many years ago, I trained in a hospital where we would, went to a few hospitals in the United States and even in the world who actually treated the spasm. In those days, we actually made an incision in front of the ear all the way down and dissected out across the face all the muscles that come across that stimulate the muscles in your face and we would diagram what muscles were going into spasm before surgery and then we would dissect out and isolate all the branches of the facial nerve that supplies innervation to the muscles in the face and then we would take a little stimulator and then tap the different branches to see which one led to where the muscle was going into spasm. We would actually cut that nerve and take a piece of the nerve out so the two ends could not touch to try to grow them back together. That was before there was Botox, that was how we treated blepharospasm and you had to be very careful because this is permanent. So you don’t wanna cut something that paralyze part of someone’s face that would have them trouble chewing or something like that happen so you have to be very delicate about what we did.
And then after my residency then the Botox came out which is Botulinum toxin, and Botox paralyzes the muscles. The great thing about Botox is, it works really well and also if something is overdone, then the Botox then wears off, which is also a bad thing about Botox because you have to keep giving injections.
So today’s treatment of essential blepharospasm is actually giving Botox injections in the area where the spasms are going on and that’s what we did for this lady today. We gave her Botox injections because she was having a spasm all the way down to the muscles in her neck. And so this is, one, is socially embarrassing. Two, it’s uncomfortable. And three, if it’s happening on the both sides, you can’t see until the spasm goes away. This is different from someone’s eyelid twitching a little bit. It’s not the same as your eyelid twitches a little bit.
This is actually a spasm and there are still some doctors today, as the spasm stays around the eye, who will go in and sorta like do a blepharoplasty where we go in and take the extra skin out and take a little strip of muscle at the same time. These doctors are going in and taking a lot of the muscle out that’s going into spasm and so you don’t have the spasm. So there are still some few isolated centers around the country who’re doing myectomies, that is taking a piece of the muscle out for treatment of blepharospasm. But really the essential treatment is Botox injections. The thing is you have to have injections every four or five months and to keep repeating those because it wears of.
So, it’s say, an unusual disease. There’s actually an Essential Blepharospasm Society. There’s a website because these people have been so miserable for a lot of their lives that they actually banded together and have an organization.
The other thing is, some people even try to do who have the spasms, is they wear glasses and they put little pieces of metal across their glasses to keep their lids up so they won’t squeeze closed. Not very comfortable to wear but if they’re having that much trouble they’re actually wearing glasses but there’s a device that goes across to keep the lids from closing all the way.
So anyway, that’s just an interesting lady we do have a treatment with the Botox and so she does very well with those. That was today’s Case of the Day. If you have any questions about that, please contact us through the website and may God bless you with healthy eyes and great vision.