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Frontalis Suspension in Essential Blepharospasm

Peter Roggenkämper, M.D.
University Eye Clinic
Bonn, Germany

Botulinum toxin is a very effective therapy in most cases of essential blepharospasm. In a small percentage, however, it is not efficient even in repeated attempts. In these cases, we perform an operation (frontalis suspension) so that lid opening by fingers is no longer necessary. In this operation, the eyebrow area is connected with the upper lid by sutures located deeply under the skin. As soon as the patient lifts the eyebrows, the eyes will be open, but, when necessary - especially during sleep - the eyes can be closed easily. Additional Botulinum toxin injections into the lid-closing orbicularis muscle facilitate this mechanism.

Until now, 53 patients have undergone this surgery. In order to evaluate the effectiveness of the operation, we asked the patients to mark subjective improvement in a percentage scale between 0% (=no improvement) and 100% (=no complaints any more). There was a significant variation in the results, the average value was 59.5% ± 30.2, range 0-100%. The mean follow up was 42.6 months ± 24.8, range 2-82 months. The operation was without any effect only in 3 cases.

So we recommend this operation (which is a non-mutilating and reversible procedure) in appropriate cases. It can be done under local anesthesia and its complication rate is low.

Presented at:
Benign Essential Blepharospasm Research Foundation Conference
Asilomar, California
September 17 - 19, 1999

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