Apraxia of Lid Opening Workup

  • Author: Marta Ugarte, MBBS, PhD, DPhil, MRC(Ophth); Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 9, 2012
 

Approach Considerations

Neuroimaging studies using computed tomography (CT) scanning or magnetic resonance imaging (MRI) may help reveal whether a pathologic condition (eg, atrophy or infarct) is present in the cortex, basal ganglia, or rostral midbrain.

Positron emission tomography (PET) may be used to assess brain function by mapping glucose metabolism in neurons. PET studies of patients with apraxia of lid opening (ALO) have demonstrated glucose hypometabolism in the basal ganglia,[14] the medial frontal lobe (unilaterally or bilaterally),[14, 15] and the primary visual cortex,[15] suggesting abnormal neuronal activity.

Levator palpebrae superioris (LPS) and orbicularis oculi (OO) activity may be assessed by using electromyographic (EMG) recordings from these muscles during lid movements. Neuropsychological testing may reveal the presence or absence of frontal lobe pathology.

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Contributor Information and Disclosures
Author

Marta Ugarte, MBBS, PhD, DPhil, MRC(Ophth)  Clinical Lecturer in Ophthalmology, University of Manchester, UK

Marta Ugarte, MBBS, PhD, DPhil, MRC(Ophth) is a member of the following medical societies: Association for Research in Vision and Ophthalmology, British Medical Association, International Society of Ocular Trauma, Royal College of Ophthalmologists, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Simon K Law, MD, PharmD Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Ron W Pelton, MD, PhD Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Plastic and Reconstructive Surgery, AO Foundation, and Colorado Medical Society

Disclosure: Nothing to disclose.

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Diagram of the possible central pathways involved in the generation of inhibitory responses of the levator palpebrae superioris muscle. Caudal central nucleus (CCN), central caudal subdivision of the oculomotor (III) nucleus.
A man with apraxia of lid opening is unable to open his lids at will. Eye movements were full. Attempted eye opening resulted in frontalis muscle contraction, backward thrusting of the head, and pretarsal orbicularis oculi activity. Spontaneous reflex blinking was normal. The lids remained open following manual elevation.
 
 
 
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