Benign Unilateral Apraxia of Eyelid Opening

Abstract

To report a case series of patients with benign unilateral apraxia of eyelid opening. Retrospective, observational case series. Five patients with unilateral transient ptosis after sleep from a single neuro-ophthalmology practice. A list of 208 patients with ptosis seen at a single neuro-ophthalmology practice was drawn through the computer coding system. Transcribed reports of the outpatient visits of these patients were reviewed from this database to identify the final diagnoses. All patients with a diagnosis of ptosis resulting from underlying neurologic, myopathic, or neuromuscular problems were excluded. Five patients with ptosis that occurred on awakening and resolved after mechanical eyelid elevation were included. The main outcome measure was identifying and defining a group of patients with a benign clinical entity causing ptosis that can cause a clinical dilemma. Three of 5 patients were women. Ages ranged from 49 to 71 years. All patients experienced complete ptosis only on awakening after sleep. The ptosis was unilateral and did not recur after manual elevation of the eyelid. None of the patients had any underlying neurologic problem that could be contributory and were thoroughly investigated with neuroimaging and laboratory testing, including acetylcholine receptor antibodies. Examination revealed no ocular cause for the ptosis in each patient. In all patients, follow-up telephone reports noted no subsequent condition that could be responsible for ptosis. The identification and diagnosis of this form of isolated ptosis, which herein is termed benign unilateral apraxia of eyelid opening, is of importance in that extensive evaluation is not warranted unless there are other neurologic or ocular findings.