Look Beyond the Clinical Picture - Apraxia of Eyelid Opening

Apraxia of Eyelid Opening (ALO) is a clinical diagnosis characterized by the difficulty of voluntary eyelid opening following voluntary or involuntary closure. Eyelid functional impairment can be traced back in the literature to 1907 by Lewandowsky but Goldstein et al was the first ophthalmologist to describe the term in 1965. ALO, despite the name, is a focal eyelid dystonia, in which there is an inability to initiate eyelid opening despite the frontalis muscle contracting and without involuntary orbicularis oculi activity. ALO has been described in isolation, but it is often accompanied by blepharospasm. The dystonia has also been associated with other conditions including but not limited to movement disorders, central nervous system (CNS) lesions, medications, genetic mutations, neuroinflammatory disorders, and deep-brain stimulation (DBS).