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The patient is somewhat unable to open the tightly closed eyelids on command though she can open them voluntarily. Some authorities do not consider this phenomenon as apraxia. The pathophysiology is not fully understood but the general consensus is that it is an abnormality in the supranuclear control of voluntary elevation of the eyelid where simultaneous activation of levator palpebrae superioris and inhibition of orbicularis oculi is deranged. It is commonly seen in lesions in the non-dominant hemisphere, medial frontal lobe, basal ganglia and the rostral brainstem. It is found in progressive supranuclear palsy, advanced Parkinson’s disease, Huntington’s disease, choreoathetosis, idiopathic dystonia, hydrocephalus, post-encephalitic parkinsonism and neuroacanthocytosis. Toxins and drugs like, lithium and sulpiride are also implicated in the etiopathogenesis. Apraxia of eyelid closing is found in some of the above-mentioned conditions and also in motor neuron disease.