 While often an isolated condition, ALO sometimes occurs in conjunction with blepharospasm, which may complicate the diagnosis and treatment.Additionally, several diseases as well as medications have been reported in association with ALO.It has been reported in cases of extrapyramidal disorders, including Parkinson’s disease, parkinsonism, progressive supranuclear palsy, hydrocephalus, motor neuron disease, Shy–Drager syndrome, and various lesions in the brain.