Successful Treatment of Apraxia of Eyelid Opening With Bromocriptine: A Case Report

Apraxia of eyelid opening (AEO) is a rare neurological disorder characterized by an inability to voluntarily initiate eyelid elevation despite preserved eyelid musculature and strength. Our case involved a 71-year-old female pianist who developed AEO following a ruptured basilar artery tip aneurysm complicated by right thalamic infarction, midbrain edema, intraventricular hemorrhage, and subarachnoid hemorrhage. During inpatient rehabilitation, examination demonstrated an inability to initiate the act of opening her eyes after closure despite preserved eyelid strength and the absence of blepharospasm or ptosis. This was consistent with AEO, which is primarily a clinical diagnosis. She also exhibited aphasia, limb apraxia, apraxia of speech, left hemineglect, and incomplete quadriparesis. Bromocriptine 2.5 mg nightly was initiated, off-label, to target her neglect and apraxia. Within three days, she regained the ability to voluntarily open and close her eyes. Concurrent improvements were observed in limb apraxia and apraxia of speech, allowing greater participation in rehabilitation, including resumption of piano playing. She continued to improve functionally and was ultimately discharged home with her family. Given the limited evidence supporting pharmacologic management of AEO, bromocriptine may represent a potential therapeutic option in appropriately selected patients with supranuclear eyelid opening dysfunction. Additional case series and prospective studies are needed to better define its efficacy, safety, and role in the management of AEO.