Straube A, Büttner U (eds): Neuro-Ophthalmology.

Dev Ophthalmol. Basel, Karger, 2007, vol 40, pp 110–131

The Eyelid and Its Contribution to

Eye Movements

C. Helmchen, H. Rambold

Department of Neurology, University of Lübeck, Lübeck, Germany

Abstract

Lid and electromyographic recordings have contributed significantly to our understanding of clinical lid disorders. Tonic lid disorders (e.g. ptosis, blepharospasm, lid retraction, blepharocolysis) can be distinguished from dynamic lid disorders (lid lag) and from specific deficits of eye-lid coordination (e.g. lid nystagmus). Electromyographic recordings allow the identification of specific lid disorders that benefit from effective therapeutic interventions, e.g., botulinum toxin injections. Rapid lid closure (blink), which exerts substantial neural influence on oculomotor systems without obscuring vision, can be used for the diagnosis of brainstem disease.

Copyright © 2007 S. Karger AG, Basel

Whereas clinicians often use peripheral eyelid disorders for a topologic diagnosis, supranuclear eyelid disorders have received little attention. Over the past 15 years, considerable progress has been made in our understanding of the supranuclear control of eyelid function. Moreover, several lines of evidence indicate a strong interaction between the neural control of eyelid and eye movements. Therefore, this chapter has three aims. First, the current knowledge of the anatomic and physiologic basis of eyelid movements will be reviewed, with particular emphasis on the supranuclear control of eyelid movements and eyelid coordination. Subsequently, the recent evidence for substantial interaction between eyelid and eye movements will be given (e.g. saccades and smooth pursuit eye movements) and the clinical implications. Finally, a variety of clinical eyelid disorders will be discussed.