To the Editor.
—The article by McCord et al1 presented a convincing argument for stripping the eyelid and eyebrow muscles in essential blepharospasm. McCord is an outstanding authority in oculoplastic surgery and both he and Gillium and Anderson2 (who devised the operation) and their co-workers should be congratulated for their work. There are some points, however, that should be emphasized in the treatment of blepharospasm by facial neurectomy or muscle stripping. First, the nerve avulsion and orbicularis-eyebrow muscle stripping operations are destructive, not curative. Selective avulsion of the facial nerve aims at destroying enough function so that the involuntary eyelid spasm is relieved, yet preserve enough eyelid closure to prevent corneal exposure. Similarly, orbicularis-eyebrow muscle stripping aims at removing just enough muscle to achieve the same result. Both procedures have a significant incidence of problems and reoperations. The surgeon is walking a tightrope with undercorrection on one side
Small RG. Essential Blepharospasm. Arch Ophthalmol. 1984;102(7):972-973. doi:10.1001/archopht.1984.01040030780015