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



• 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.


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