Neurological Eyelid Disorders Study Set | Medicine Terms & Definitions

Levator palpebrae

muscle that is innervated by the superior division of CN 3 and functions to maintain the elevated posture of the upper lid. Its movement is synkinetic with related ocular and facial muscles. Both eyes are identically coordinated as they follow Hering's law of equal innervation.

Bell's phenomenon

due to the fact that the levator palpebrae is interconnect with CN 3 and 7 via the central caudal nucleus, the globe moves up and out with lid closure.

Mueller's muscle

muscle of the upper and lower lids that is innervated by the 3rd order neuron oculo-sympathetic pathway and functions to maintain lid posture.

upside down ptosis

Dysfunction of Mueller's muscle secondary to the disruption of the oculo-sympathetic pathway may be responsible for ____ seen in Horner's syndrome

Orbicularis oculi

muscle that is innervated by CN 7 and functions to close the upper and lower lids.

Marcus-Gunn jaw winking

the most common congenital synkinesis linking jaw movement to lid movement.

External pterygoid levator synkinesis

version of Marcus-Gunn jaw winking where the lid elevates upon opening of the mouth

Internal pterygoid levator synkinesis

version of Marcus-Gunn jaw winking where the lid elevated upon closure of the mouth

Supra-nuclear lesions

CN 3 lesions

Lesions of the oculo-sympathetic pathway (I.e. Horner's)

Ophthalmoplegic migraine

4 causes of Acquired Ptosis

Myasthenia gravis

disease involving an antibody mediated destruction of acetylcholine receptors impairing neuro-muscular transmission. Is characterized by skeletal muscle weakness and fatigue with periods of remission and exacerbations triggered by stress (I.e. infection, trauma).

75%

percentage of myasthenia gravis patients that have an initial manifestation of ptosis that worsens with sustained up gaze or fatigue. Pupil and ciliary muscles are unaffected.

90%

percentage of myasthenia gravis patients having ocular involvement.

Dysthyroidism/TED, thymoma, collagen vascular disorders

three systemic conditions that are associated with myasthenia gravis

Cogan's lid twitch sign

overshooting of the upper lid upon returning to primary gaze after 10-15 seconds of downward gaze.

Enhanced ptosis

in a myasthenia gravis patient lifting of the normal appearing eyelid commonly leads to increased ptosis of the already ptotic eyelid.

Peek sign

slight opening of the lids after forced closure tires the orbicularis muscle seen in myasthenia gravis.

Ice pack test

test for myasthenia gravis having high sensitivity and specificity. Is positive when there is a resolution of ptosis after a 2 minute application of an icepack to the ptotic lid.

Tensilon test

test for myasthenia gravis involving the administration of edrophonium chloride. If muscle become stronger after drug administeration, this test is considered positive for myasthenia gravis.

Sleep test

test for myasthenia gravis involving resolution of ptosis with sleep that reappears 30 seconds to 5 minutes after waking.

Anti MuSK test

diagnostic antibody test used in the diagnosis of myasthenia gravis in patients who are negative for acetylcholine receptor antibodies.

Penicillamine

Quinidine

Propranolol

Lithium

Aminioglycosides (I.e. gentamycin)

5 Drugs Exacerbating Myasthenia Gravis

Pyridostigmine (Mestinon)

primary drug prescribed in the treatment of myasthenia gravis

Chronic progressive ophthalmoplegia

group of disorders characterized by progressive symmetric immobility of the eyes due to mitochondrial DNA mutation.

trichrome stain

Muscle biopsy with a ____ can be used to diagnose chronic progressive ophthalmoplegia as it will show "ragged red" fibers between myfibrils

Myotonic dystrophy

an autosomal dominant disorder characterized by dystrophy of muscles, tissues, and organs that causes myotonia (persistent contraction of muscles).

steroids

Long term treatment of uveitis with ____ may induce a localized myopathy and therefore cause ptosis

botulism

infection by an anaerobic organism that blocks acetylcholine and has the ability to cause ptosis

Collier's sign

bilateral lid retraction that is indicative of a lesion of the rostral dorsal midbrain of the posterior commissure.

Setting sun sign

lid retraction in addition to downward displacement of the eyes.

Duane's syndrome

horizontal gaze abnormalities with lid retraction in the restriction field of gaze.

Pseudo von Graefe's sign

retraction of the upper lid in downgaze caused by aberrant regeneration of CN 3.

Claude Bernard Horner's syndrome

lid retraction of one eye with an enlarge pupil with ptosis of the contralateral eye with a Horner's pupil. Is caused by a lesion of the oculo-sympathetic pathway

maternal hyperthyroidism

Myopathic congenital transient lid retraction may result due to...

phenylephrine, Muller's muscle

Neuromuscular lid retraction may result due to the administration of sympathomimetic drops such as ___ that stimulate ___

Thyroid eye disease

Parkinson's disease

Progressive supranuclear palsy

3 Causes of Lid Retraction in Down Gaze

Cortical

Subcortical

Extrapyramidal

Peripheral

4 Controls of Eyelid Closure

12-16, decreased, increased

The normal blink rate is ___ times per minute with ____ rates during concentration and ____ rates with stress or anxiety

saccades, brainstem

Blinks facilitate the generation of ____ to change direction of gaze. ____ diseases require blinking in order to initiate eye movements.

Huntinton's disease, Gaucher's disease, Parkinson's disease

three brainstem disease that require the blink saccade synkinesis to initiate eye movements

vertebral and basilar, CN 7

Hemifacial spasm may occur due to dilation of the ____ (2) arteries compressing the dorsal root of ____

slow, fast

Eyelid nystagmus occurs vertically having a ___ movement downwards and a ____ movement upwards

convergence

Eyelid nystagmus may be seen with _____ in multiple sclerosis

gaze shifts

Eyelid nystagmus may be seen in with ____ in brainstem or cerebellar damage

Meige's syndrome

syndrome causing orofacial dyskinesia and blepharospasm