Surgical Management of Essential Blepharospasm: Long-Term Results After Orbicularis Myectomy

PURPOSE: To evaluate the long-term functional and aesthetic outcomes of orbicularis myectomy in patients with medically refractory benign essential blepharospasm and to contextualize findings within current surgical literature. METHODS: A retrospective analysis was conducted on 80 patients (129 eyelids) who underwent subtotal orbicularis myectomy between 2014 and 2023. Bilateral procedures were performed sequentially. Mean follow-up was 84 months (range: 24-144.3). Surgery was offered after failure of initial botulinum toxin injections, with a mean delay of 18.5 months. RESULTS: At 6 and 12 months postoperatively, 72% of patients experienced functional improvement, with a mean 53% reduction in spasm severity. However, only 41% maintained long-term benefit. Spasms recurred in 86%, and only 7.5% achieved complete resolution without further botulinum toxin injections. Aesthetic outcomes were favorable in 96% of cases and remained stable over time. The frequency of botulinium toxin injections decreased from 1 every 3 months to every 4 months, though this change was not statistically significant (p = 0.12). Botulinum toxin dose was significantly reduced at 12 months (p < 0.001), but not at final follow-up (p = 0.2872), suggesting a temporary postoperative benefit. No major complications were observed. Transient lagophthalmos occurred in 3% of cases; 1 case required surgical revision. There was no significant association between long-term disabling symptoms and age (p = 0.61), gender (p = 0.12), or active smoking (p = 0.49). CONCLUSION: Orbicularis myectomy provides early symptom relief and durable cosmetic improvement, but its functional effect tends to decline over time. Minimally invasive techniques may help reduce complications while maintaining efficacy.