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Eyelid ptosis from sympathetic nerve dysfunction mistaken as myopathy: a simple test to identify this condition
  1. G Tomelleri1,
  2. G Vattemi1,
  3. M Filosto2,
  4. P Tonin1
  1. 1Department of Neurological Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
  2. 2Department of Medical and Surgical Sciences, Clinical Neurology, University and Hospital “Spedali Civili”, Brescia, Italy
  1. Correspondence to:
 Dr Giuliano Tomelleri
 Department of Neurological Sciences and Vision, Section of Clinical Neurology, Piazzale L.A. Scuro 10, 37134 Verona, Italy; giuliano.tomelleri{at}


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.

  • AchR, acetylcholine receptor
  • EMG, electromyography

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  • Competing interests: None.

  • Informed consent was obtained for publication of fig 1.

  • Published Online First 6 February 2007