HIV-associated blepharoptosis consistent with myopathy

This small retrospective case series evaluated HIV-positive patients with an unusual blepharoptosis. The authors found that the patients’ reduced levator excursion, lack of levator dehiscences at surgery, absence of current AZT therapy and histopathologic findings were most consistent with a diagnosis of HIV-associated myopathy.

The study included 10 patients with HIV/AIDS and bilateral symptomatic blepharoptosis with reduced levator excursion. They were all receiving highly active antiretroviral therapy (HAART) for HIV management. Their mean MRD1 was 0.7 OD and 0.6 OS, whereas mean levator excursion was 12 OD and 13 OS. None of them was taking zidovudine (AZT) at presentation.

Nine patients underwent large bilateral levator resections for correction of blepharoptosis. Histopathology from six of them showed abnormal levator muscle fibers with variable degrees of atrophy, fibrosis and regeneration without inflammation.

The authors note that early histopathologic studies of muscle biopsies in HIV-positive patients, before the advent of AZT and other antiretroviral medications, demonstrated a distinct HIV-associated myopathy. They say that the levator muscle findings in the current study bear a striking resemblance to these initial descriptions.

None of the patients in the current study had clinical or historic findings consistent with other common myogenic or neurogenic causes of ptosis, and none showed signs of more generalized myopathy. Four patients had a known history of AZT use, but there was no evidence that their ptosis was related to this treatment, which was discontinued long before eyelid symptoms developed.

The authors conclude that surgical management with large levator resections provides optimal correction of HIV-associated blepharoptosis, given the myopathic process.