Surgical management for blepharospasm and apraxia of eyelid opening in a patient allergic to botulinum toxin: A therapeutic challenge
Author: Estel·la Rojas
Base Hospital / Institution: Barraquer Ophthalmology Centre
ePoster presentation
Abstract ID: 24-274
Purpose
Our aim is to demonstrate therapeutic alternatives for benign essential blepharospasm when botulinum toxin cannot be administered.
Methods
Case report.
Results
A 62-year-old woman sought a second opinion at our centre. She had a previous diagnosis of benign essential blepharospasm and had undergone treatment with botulinum toxin, which yielded a partial response. However, the treatment had to be discontinued due to an allergic reaction to one of its components. Subsequently, she underwent partial orbiculectomy surgery on her right eye but experienced no improvement. At our clinic, she exhibited a visual acuity of light perception in both eyes, along with apraxia of eyelid opening. In light of these findings, we selected a combined surgical approach involving total orbiculectomy, levator aponeurosis resection, and blepharoplasty in both eyes. This procedure successfully restored complete eyelid opening bilaterally, although residual lagophthalmos persisted in the right eye. The most notable outcome was the improvement of visual acuity from functional blindness to 20/40, restoring the patient’s independence for daily activities and thus increasing her quality of life.
Conclusion
Botulinum toxin injections are the first-line treatment for benign essential blepharospasm. However, apraxia of eyelid opening may be a significant cause of treatment failure with botulinum toxin, and the patient’s allergy to botulinum toxin components makes its management even more challenging. It has been established that a combination of surgical interventions yields better functional outcomes than individual treatments. In conclusion, treating this condition can be challenging at times, but there is a clear consensus regarding the need for individualized management.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Rafael | Ollero | Barraquer Ophthalmology Centre |
| Sandra | Planella | Barraquer Ophthalmology Centre |
