Pitfalls in diagnostic and treatment procedure for eye opening and closing disturbance

We describe the main causes for eye opening and closing disturbances as well as the pitfalls of the diagnostic processes. With oculomotor nerve palsy, attention need to be paid to uncommon causes and special care should be taken if there is any possibility of a cerebral arterial aneurysm, with a neurosurgeon consultation set up as soon as possible in such cases. Lung cancer, cervical root avulsion and cervical syringomyelia cause Horner's syndrome. On the other hand there is the possibility that such symptoms in atypical lateral medullary infarction or medullary hemorrhage might be lacking. Myasthenia gravis causes ptosis and in 15-20% of the cases a negative anti-ACh receptor antibody is observed. In such seronegative cases, a positive MuSK antibody has been reported to be present. It is thought that dystonia causes many cases of blepharospasm. Because long-term administration of antipsychotic drugs can cause blepharospasm, associations with psychiatrists are necessary when treating drug-induced dystonia cases. Additionally, it has been observed that in some blepharospasm cases, botulinum toxin therapy on just one side can sometimes induce exacerbation in the contralateral eye closure.