I have recently started experiencing awakening ptosis, it is associated with autoimmune diseases and ocular pathology.
Just wondering If anyone else with Behcets has it?
Awakening ptosis (AP) (transient complete ptosis confined to awakening from sleep that resolves with mechanical elevation of the eyelids) is a rare clinical presentation.
AP appears to be associated with autoimmune disease and a history of ocular pathology. As has already been mentioned, the ptosis of AP resolves when the patients mechanically elevate their eyelids, whereas AEO patients may try manoeuvres such as lightly touching their temple regions, using their frontalis muscle to elevate their eyebrows or engaging in backward thrusting of their head, in attempts to open their eyes. AP frequently resolves within 18 months of symptom onset; on the contrary, a review of patients with isolated AEO reported an average disease duration of more than 4 years, with a range between 1 and 8 years. Thus, given these vast array of dissimilarities, it is likely that AP and AEO represent separate clinical entities.
AP is a well-defined clinical entity with a benign nature. It is predominantly unilateral, typically affects white Caucasian women around 60 years of age with a history of autoimmune and/or ocular conditions, and usually resolves spontaneously within 18 months. AP has distinct differences to AEO, and it may represent a rare and currently unrecognized sleep disorder. I propose for the first time the essential criteria for the diagnosis of AP: (a) recurrent transient ptosis (unilateral or bilateral) confined to awakening from sleep; (b) spontaneous eyelid opening after a few minutes or upon mechanical elevation, after which complete volitional control is regained; and (c) not associated with known neurological or ophthalmological causes of ptosis. Clinicians encountering patients with AP can reassure their patients that their condition is likely to be benign, and that it will probably resolve in a number of months without any intervention. However, identification of a treatment would be particularly beneficial for those patients whose symptoms persist for several years. Clinicians should also be aware that laboratory testing and neuroimaging are not indicated in these patients, as patients with AP that have been investigated with neuroimaging and laboratory tests have all shown normal findings.1–3
There is still much that is not known about AP. For example, accurate prevalence data are lacking. Even though the small number of patients in the studies by Cherian and Foroozan and Reggie et al. might indicate that AP is very rare, it would nevertheless be useful to establish the relative prevalence of AP in neuro-ophthalmology practices outside of North America. With respect to the pathophysiology of AP, detailed investigations of patients using polysomnography would help to confirm sleep-related muscular atonia as the cause of transient ptosis confined to awakening from sleep, as well as to identify any additional changes in sleep architecture, such as sleep fragmentation. Interestingly, AP has not received a mention in current sleep medicine classification systems or textbooks.25,26 Given that AP may represent a novel parasomnia, sleep physicians ought to be aware of this condition, alongside neurologists and ophthalmologists