Chemomyectomy of the Orbicularis Oculi Muscles for the Treatment of Localized Hemifacial Spasm

OBJECTIVETo report our experience with doxorubicin chemomyectomy as an alternative to other treatments for hemifacial spasm (HFS). DESIGNA prospective, open study Phase I clinical trial of chemomyectomy. SETTINGA hospital-based, referral neuro-ophthalmology and oculoplastic service. PATIENTS AND METHODSRepeated (1–6, median4) local injections of doxorubicin were given in the eyelids of 8 patients (5 men, 3 women, average age71). MAIN OUTCOME MEASURESEyelid strength, self-reported spasm, and duration of improvement without seeking additional or alternative treatments. RESULTSChemomyectomy resulted in permanent (≥2.5 years) orbicularis oculi weakness and relief from spasms in the treated areas in 5 patients, although 2 patients requested occasional supplementary botulinum toxin (BT) injections in the facial muscles over the cheek. One patient had a successful result for 3 years, after which spasm recurred. One patient maintains a successful result in the eyelid but had a failed microvascular decompression in the lower face. One incompletely treated patient required microvascular decompression following spread of spasms to the lower branches of the facial nerve and increased severity of the HFS. One patient required eyelid surgery because of concurrent spastic entropion. One patient treated with a higher concentration than currently used required closure of a skin ulcer. CONCLUSIONSDoxorubicin chemomyectomy is an effective alternative to conventional therapy for properly selected patients affected by HFS, particularly older patients with relatively localized eyelid muscle spasms. The modified technique of doxorubicin chemomyectomy has developed to the point where its safety is demonstrated and its risks are known.