An Unusual Palpebral Movement: Lid Nystagmus

Lid nystagmus is an unusual rhythmic upward jerking of the upper eyelids that occurs in isolation or relation with the eye movements, secondary to compressive lesion. It is considered a sign of intrinsic midbrain disease. However, this present case developed nystagmus in the setting of III nerve aberrant regeneration. A 31-year-old woman with a III nerve palsy due to grade IV of glioblastoma in the temporal lobe, left cavernous sinus, underwent surgery, followed by radiotherapy and chemotherapy. The patient developed signs of III nerve aberrant regeneration. After three years, left palpebral nystagmus was evident in rest and in all eye positions except when attempt to look up. The cerebral magnetic resonance showed tumor increase. Lid synkinesis etiopathogenesis is unknown. Most hypothesis suggest abnormal disruption of the pretectal inhibitory influence on the levator motoneurons. In this case, probably the tumor growing caused more abnormal regeneration movements in the III nerve branches.