PMID- 17576707
OWN - NLM
STAT- MEDLINE
DCOM- 20070730
LR  - 20100702
IS  - 0007-1161 (Print)
IS  - 1468-2079 (Electronic)
IS  - 0007-1161 (Linking)
VI  - 91
IP  - 7
DP  - 2007 Jul
TI  - Apraxia of lid opening.
PG  - 854
AB  - We describe eyelid movement abnormalities in an 80-year-old man with apraxia of 
      lid opening (ALO), resulting from involuntary levator palpebrae inhibition (ILPI) 
      and pretarsal orbicularis oculi (OO) contraction. He was unable to open his lids 
      at will following closure. Attempted eye opening resulted in forceful contraction 
      of the frontalis muscle, backward thrusting of the head and lengthened lid 
      closure. The inability to reopen the lids was not evident during spontaneous 
      reflex blinking and he had no difficulty in keeping the lids open once they had 
      been manually lifted up. There were no episodes of involuntary drooping of the 
      eyelids or spasmodic contraction of the OO causing involuntary eyelid closure. 
      Pursuit eye movements were not restricted, the vestibulo-ocular reflex was 
      preserved and both horizontal and vertical saccades were normal. Despite the 
      clinically visible persistence of pretarsal OO activity, treatment with botulinum 
      toxin injections in the pretarsal and preseptal portions of the muscle did not 
      reduce his difficulty in initiating lid elevation but he found some benefit using 
      lid crutches. ALO is thought to be due to an abnormality in the supranuclear 
      control of eyelid movement. ILPI can present either isolated or combined with 
      blepharospasm. The excitatory levator palpebrae response necessary to lift the 
      lids up is likely to be in very close connection with the OO antagonistic 
      inhibitory response. Alterations in one or another pre-motor structure may result 
      in inability to raise the lids due to inhibition of the levator palpebrae as well 
      as persistence of the pretarsal OO.
FAU - Ugarte, Marta
AU  - Ugarte M
AD  - Eye Department, Worthing Hospital, Worthing BN11 2DH, UK. mugarte@doctors.org.uk
FAU - Teimory, Masoud
AU  - Teimory M
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Br J Ophthalmol
JT  - The British journal of ophthalmology
JID - 0421041
SB  - IM
MH  - Aged, 80 and over
MH  - Apraxias/*physiopathology
MH  - *Blinking
MH  - Eyelid Diseases/*physiopathology
MH  - Humans
MH  - Male
MH  - Muscle Contraction
MH  - Muscle, Skeletal/physiopathology
PMC - PMC1955626
EDAT- 2007/06/20 09:00
MHDA- 2007/07/31 09:00
PMCR- 2010/07/01
CRDT- 2007/06/20 09:00
PHST- 2007/06/20 09:00 [pubmed]
PHST- 2007/07/31 09:00 [medline]
PHST- 2007/06/20 09:00 [entrez]
PHST- 2010/07/01 00:00 [pmc-release]
AID - 91/7/854 [pii]
AID - bj124040 [pii]
AID - 10.1136/bjo.2007.124040 [doi]
PST - ppublish
SO  - Br J Ophthalmol. 2007 Jul;91(7):854. doi: 10.1136/bjo.2007.124040.