Proprioceptive structures, muscle spindles, and palisade endings exist in the global but not orbital layer of human extraocular muscles. Distal myotendinous junctions, the areas traumatized in most strabismus procedures, are most richly endowed. The information they relay, however, remains controversial.2 Levator palpebrae superioris muscle lacks a global layer as well as proprioceptive structures.1,3 Its orbital layer has 2 types of muscle fibers. Most (80%) are fast-twitch, singly innervated, fatigue-resistant fibers and the rest (20%) are slow-twitch, multiply innervated, fatigable fibers.3 The latter likely have an MM-mediated proprioceptive role, reflexively contracting in response to voluntary contraction of the former.1,4,5 Intraoperative stretching of MM is known to induce ipsilateral or bilateral involuntary contraction of LPSM.1 Thick (proprioceptive) and thin (sympathetic) nerve fibers on proximal and distal MM are shown to pass through the palpebral lobe of the lacrimal gland to join the lacrimal nerve. Electrical stimulation of thick but not thin fibers consistently results in involuntary retraction of the upper eyelid (Hoffmann reflex).1 Ban et al4 electromyographically verified the presence of monosynaptic trigemino-oculomotor reflex ostensibly mediated via mesencephalic and central caudal nuclei of the fifth and third cranial nerves and speculated that it may account for inexplicable ptosis following trauma, surgery, or tumor removal in the aponeurotic area of LPSM. The horseradish peroxidase technique has shown that fibers from the oculomotor nerve entering the trigeminal (ophthalmic) nerve are afferent in nature.5 A hyperactive monosynaptic trigemino-oculomotor reflex resulting from stretch by multiply innervated slow-twitch fibers as elaborated earlier1,4,5 likely gave rise to sustained, fatigable eyelid elevation here.