Isolated Eyelid Nystagmus: Case Report and Nosological Considerations

Eyelid Nystagmus and Other Involuntary Movements of the Upper Lids; What's in a Name?

“…Historically, there have been three types of eyelid nystagmus reported. These are described and discussed by Ord as et al, 1 in this issue and well summarized and referenced in their Table 1. 1 The most common is that associated with vertical ocular nystagmus, such that with upbeat nystagmus there is an upper lid movement (upward jerk) synchronous with the globe, but with an exaggerated excursion.…”

“…These are described and discussed by Ord as et al, 1 in this issue and well summarized and referenced in their Table 1. 1 The most common is that associated with vertical ocular nystagmus, such that with upbeat nystagmus there is an upper lid movement (upward jerk) synchronous with the globe, but with an exaggerated excursion. The second type is associated with gaze-evoked horizontal nystagmus so that there is an upward jerk of the lid jerks simultaneously with the fast phase of the horizontal gaze-evoked nystagmus.…”

“…In this issue, Ordás and colleagues 1 report a case of “eyelid nystagmus” in a 75‐year‐old woman presenting with 5 years progressive gait disorder on a background of hypertension. Other than the eyelid nystagmus, the only abnormal features were limb hyperreflexia and a “slow gait with decreased step height” interpreted as a “higher‐level gait disorder”.…”

“…A number of abnormal upper lid abnormal movements have been described, with terms that include lid nystagmus, lid fluttering, lid hopping, lid tremor, lid myoclonus, lid myokymia, lid fasciculations, and, by Ordás and colleagues 1 in this issue, lid myorhythmia. Rarely, such movements are confined to the upper lid (ie, isolated), whereas some are associated with simultaneous ocular movements (eg, most cases of lid nystagmus, eyelid myoclonus), and others with contractions of orbicularis oculi (eg, blepharoclonus and blepharospasm).…”

“…Ordás et al 1 propose that their patient exhibited “a form of slow tremor or a form of myorhythmia” with electromyography of the levator palpebrae exhibiting a semi‐rhythmic activity of 1–2 Hz. Their accompanying video does indeed show slow semi‐rhythmic elevation and lowering of the upper lid without a clear jerk component.…”