Clark, JeremyRandolph, JohnSokol, Jason A.Moore, Nicholas A.Lee, Hui Bae H.Nunery, William R.2018-07-242018-07-242017-11-05Clark, J., Randolph, J., Sokol, J. A., Moore, N. A., Lee, H. B. H., & Nunery, W. R. (2017). Surgical approach to limiting skin contracture following protractor myectomy for essential blepharospasm. Digital Journal of Ophthalmology : DJO, 23(4), 99–103. http://doi.org/10.5693/djo.01.2016.11.001https://hdl.handle.net/1805/16785Purpose: To report our experience with protractor myectomy in patients with benign essential blepharospasm who did not respond to serial botulinum toxin injection, and to describe intra- and postoperative techniques that limited skin contracture while also providing excellent functional and cosmetic results. Methods: The medical records of patients with isolated, benign, essential blepharospasm who underwent protractor myectomy from 2005 to 2008 by a single surgeon were reviewed retrospectively. The technique entailed operating on a single eyelid during each procedure, using a complete en bloc resection of all orbicularis tissue, leaving all eyelid skin intact at the time of surgery, and placing the lid under stretch with Frost suture and applying a pressure dressing for 5-7 days. Results: Data from 28 eyelids in 7 patients were included. Average follow-up was 21.5 months (range, 4-76 months). Of the 28 eyelids, 20 (71.4%) showed postoperative resolution of spasm, with no further need for botulinum toxin injections. In the 8 eyelids requiring further injections, the average time to injection after surgery was 194 days (range, 78-323 days), and the average number of injections was 12 (range, 2-23 injections). All but one eyelid had excellent cosmetic results, without signs of contracture; one eyelid developed postoperative skin contracture following premature removal of the Frost suture and pressure dressing because of concerns over increased intraocular pressure. Conclusions: In our patient cohort, this modified technique resulted in excellent cosmetic and functional results and limited postoperative skin contracture.en-USPublisher PolicyBlepharospasmContractureEyelidsFollow-up studiesOculomotor musclesOphthalmologic surgical proceduresPostoperative complicationsTreatment outcomeArticle