Intermittent reversal of complete ptosis associated with sphenoid wing meningiomas

Ptosis secondary to dense oculomotor pareses generally improves over several months, but intermittent elevation of the eyelid has not been reported. The authors describe two patients who demonstrated intermittent involuntary monocular eyelid elevation in an eye with complete ptosis caused by partial resection of sphenoid wing meningioma. Both patients had complete ophthalmoplegia and decreased corneal sensation. The involved eye was ipsilateral to a meningioma that had been debulked 11 to 12 months previously. Although the lids were devoid of volitional movement, each patient could elevate the lid for 10 to 20 seconds by either tickling the eyelashes or rubbing the eyelids. The lids occasionally rose spontaneously and there was no clinical evidence of aberrant regeneration or cyclic spasm.

Although the mechanism of action of this involuntary eyelid elevation is unknown, it is possible that some process of aberrant regeneration activated by sensory stimuli is responsible.