An HIV-positive patient on long-term antiretroviral therapy may develop blepharoptosis (blepharo = eyelid) and an external ophthalmoplegia.
Clinical findings:
(1) ptosis of the eyelids
(2) decreased extraocular muscle movements
Risk factors:
(1) long-term HAART (highly active antiretroviral therapy) that includes both a thymidine analogue and a protease inhibitor
(2) onset of lipodystrophy 2 or more years previously
(3) presence of other myopathic findings (proximal muscle weakness, dysphagia)
(4) presence of peripheral neuropathy, deafness and/or cardiac conduction defect
where:
• The muscle involvement is part of a generalized mitochondrial myopathy.
Surgical repair of the ptosis requires a greater advancement of the levator aponeurosis and muscle because of the muscle involvement.
