Purpose of review: Botulinum toxin (BTX) injections are the main medical treatment of facial dystonias, but injections are ineffective in some patients. This review discusses the indications for myectomy and surgical technique for treating benign essential blepharospasm (BEB) and apraxia of eyelid opening (ALO).
Recent findings: There are four reasons to consider myectomy for patients with BEB. The first is ALO associated with BEB. The second is patients with blepharospasm-associated deformities. The third is patients who are truly unresponsive to BTX. The fourth is patients who cannot afford or who refuse BTX injections.
Summary: Myectomy remains essential for treating blepharospasm patients and the most common indication is those with associated ALO.