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April 1985

Band Keratopathy After Orbicularis Extirpation for Essential Blepharospasm

Arch Ophthalmol. 1985;103(4):475. doi:10.1001/archopht.1985.01050040017002

To the Editor.  —In 1981, Gillum and Anderson1 pioneered treatment of essential blepharospasm by surgical extirpation of the upper lid protractors. Recently, McCord and colleagues,2 in an independent study, showed that "orbiculectomy" compared favorably with seventh cranial nerve avulsion, effecting more cures with a single procedure and being associated with less morbidity. Both of these outstanding studies were reported in the Archives and involved a total of 39 patients. In no instance did a complication result in permanent visual loss.We performed this procedure with concomitant upper lid blepharoplasty on a 63-year-old man with essential blepharospasm, dermatochalasis, and dry eyes (Schirmer's test with anesthetic 1 mm at five minutes). The ocular exam was otherwise normal, visual acuity was 20/20 OU, and no other orofacial muscular abnormalities were noted.On the first postoperative day, visual acuity was 20/200 OD and 20/40 OS. The lids were swollen, ecchymotic, and could

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