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most effective treatment available. Injections need to be repeated approximately every three months.

In cases where little improvement results from the injections, it may be because they have not been accurately targeted, or the dose needs adjusting, or a different type of botulinum toxin is required.

Functionally impaired patients with blepharospasm who have not tolerated or responded well to medication or botulinum toxin are candidates for surgical therapy. At present, protractor myectomy (removal of some or all of the muscles responsible for eyelid closure) has proven to be the most effective surgical treatment for blepharospasm. Experience has found that myectomy has improved visual disability in 75 percent to 80 percent of cases of blepharospasm.

Furthermore, current research studies are ongoing through the National Institutes of Health in Washington, D.C. These studies include the use of mexiletine for the treatment of dystonias. Also doxorubicin injections are being used to specifically treat blepharospasm. No definitive conclusions have yet been made on the use of these drugs as the studies are underway.

In addition to facial dystonias, botulinum injections may be used to treat frown lines on the face. FDA-approved in 2002 specifically for glabellar lines, this physician-administered, non-surgical procedure has been used on over one million patients for this purpose alone. Incidentally, this same injection has been used safely in patients to treat blepharospasm for decades. Thus, this is not a new treatment on the market.

For further inquiries on the above information or an evaluation for blepharospasm or treatment of frown lines, please contact Loma Linda University Medical Center at (909) 558-2020.

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