A 73-Year-Old Woman With Progressive Ptosis

Carlo R. Bernardino, MD


January 22, 2014

Clinical Presentation

A 73-year-old woman presented with progressive ptosis of both upper eyelids. She first noted ptosis in her late 40s and had ptosis surgery in 2003, which subsequently failed. Her second surgery was done in 2008. She denied any double vision or changes in vision, but she noted progressive difficulty with swallowing.

On ocular examination, her best corrected visual acuity was 20/25 bilaterally. Pupils were normally reactive to light, with no afferent pupillary defect. Visual field testing revealed a superior visual field defect in both eyes that improved with elevation of the eyelids. Ocular motility was full.

External examination demonstrated ptosis of both upper eyelids (Figure). Margin reflex distance was 0.5 mm on both sides. Levator function was 4 mm on both sides. Orbicularis function was normal and symmetric on both sides. Examination of the anterior segment was unremarkable, and fundus examination was normal.

Figure. Photographs of the patient in (a) primary gaze, (b) upgaze, and (c) downgaze, demonstrating marked ptosis of both upper eyelids and poor levator function.


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