Apraxia of eyelid opening—An often-missed clinical sign in children

Abstract

Apraxia of eyelid opening (ALO) is characterized by the inability to voluntarily open the eyes because of impaired supranuclear control. A 6-year-old child who presented with features of respiratory tract infection with status epilepticus was influenza B positive. Magnetic resonance imaging of the brain was consistent with acute necrotizing encephalopathy of childhood. During recovery, he had difficulty opening his eyes on command despite preserved spontaneous blinking. Apraxia of eyelid opening was considered, and a trial of levodopa was initiated, following which his symptoms improved.