Eyelid ptosis from sympathetic nerve dysfunction mistaken as myopathy: a simple test to identify this condition.
Acquired isolated unilateral or bilateral blepharoptosis has many aetiologies. When the pupils are normal, a myasthenic syndrome or myopathy has to be ruled out. If the tests for myasthenia gravis are negative, the next step is to perform a muscle biopsy to establish a diagnosis. Muscle examination may show a mitochondrial disorder, non-specific abnormalities or be quite normal. We identified three patients, who had previously undergone various investigations, including a muscle biopsy, whose lid ptosis disappeared using eye drops containing naphazoline nitrate, a sympathomimetic drug, thus suggesting partial Horner's syndrome. We emphasise the usefulness of this simple and cheap test before performing more traumatic and expensive investigations.
Tomelleri
G
G
Department of Neurological Sciences and Vision, Section of Clinical Neurology, University of Verona, 37134 Verona, Italy. giuliano.tomelleri@univr.it
Vattemi
G
G
Filosto
M
M
Tonin
P
P
D000287:Administration, Topical; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000175:diagnosis; D001763:Blepharoptosis / Q000209:etiology*; D003951:Diagnostic Errors; D005260:Female; D006732:Horner Syndrome / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000175:diagnosis; D009278:Naphazoline / Q000008:administration & dosage; D009883:Ophthalmic Solutions / Q000008:administration & dosage
D000316:Adrenergic alpha-Agonists; D009883:Ophthalmic Solutions; D009278:Naphazoline